Provider Demographics
NPI:1619172244
Name:YOUNGSTEDT, ERIK SEAN (LCPC)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:SEAN
Last Name:YOUNGSTEDT
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 1:462 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1554
Mailing Address - Country:US
Mailing Address - Phone:630-681-8661
Mailing Address - Fax:
Practice Address - Street 1:346 TAFT AVE STE 030
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6296
Practice Address - Country:US
Practice Address - Phone:630-690-3170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004037101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional