MEDICARE: CYNTHIA YOUNG PETERS M.S., LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	166.000805	IL
2	106H00000X	Marriage & Family Therapist	201094	TX
3	101YP2500X	Professional Counselor	62355	TX

General Provider Information

NPI Number	:	1700934213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA YOUNG PETERS M.S., LMFT

Provider Business Mailing Address
First Line	:	900 NORTH SHORE DR
Second Line	:	SUITE 106
City	:	LAKE BLUFF
State	:	IL
Zip	:	60044-2243
Country	:	US
Telephone Number	:	224-365-4067
Fax Number	:	866-861-2168

Provider Business Practice Location Address
First Line	:	900 NORTH SHORE DR
Second Line	:	SUITE 106
City	:	LAKE BLUFF
State	:	IL
Zip	:	60044-2243
Country	:	US
Telephone Number	:	224-365-4067
Fax Number	:	866-861-2168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	12/08/2010

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