Provider Demographics
NPI:1720226905
Name:BUGAY, BRYAN (LCPC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:BUGAY
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 1:550 FRONTAGE RD
Mailing Address - Street 2:SUITE 3515
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 FRONTAGE RD
Practice Address - Street 2:SUITE 3515
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1202
Practice Address - Country:US
Practice Address - Phone:773-318-8959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005135101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional