Provider Demographics
NPI:1639419443
Name:SCOGGIN-CHANG, CHELSIE RENE' (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CHELSIE
Middle Name:RENE'
Last Name:SCOGGIN-CHANG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 W COLONIAL PKWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60067-4755
Mailing Address - Country:US
Mailing Address - Phone:224-836-1633
Mailing Address - Fax:
Practice Address - Street 1:1608 W COLONIAL PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-4755
Practice Address - Country:US
Practice Address - Phone:224-836-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
180008364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health