Provider Demographics
NPI:1194835959
Name:WOODWARD, MARK (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 N SHERIDAN RD
Mailing Address - Street 2:#2211
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1958
Mailing Address - Country:US
Mailing Address - Phone:312-343-2424
Mailing Address - Fax:
Practice Address - Street 1:77 E. WASHINGTON ST.
Practice Address - Street 2:SUITE 1925
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-343-2424
Practice Address - Fax:773-944-0233
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002973101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional