Provider Demographics
NPI:1609441013
Name:YORK, ETHAN J (LPC)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:J
Last Name:YORK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 S KOSTNER AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4219
Mailing Address - Country:US
Mailing Address - Phone:414-882-9449
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 510
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3434
Practice Address - Country:US
Practice Address - Phone:312-324-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional