Provider Demographics
NPI:1548572183
Name:DYSON, STEVEN O (LCPC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:O
Last Name:DYSON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3900
Mailing Address - Country:US
Mailing Address - Phone:312-747-0059
Mailing Address - Fax:312-747-0088
Practice Address - Street 1:6337 S WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-3707
Practice Address - Country:US
Practice Address - Phone:312-474-0059
Practice Address - Fax:312-747-0088
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL366005820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL366005820Medicaid