Provider Demographics
NPI:1750508164
Name:YOUNG, MARGO (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARGO
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60155-5818
Mailing Address - Country:US
Mailing Address - Phone:708-681-8802
Mailing Address - Fax:708-681-8802
Practice Address - Street 1:1010 W 18TH ST
Practice Address - Street 2:
Practice Address - City:BROADVIEW
Practice Address - State:IL
Practice Address - Zip Code:60155-5818
Practice Address - Country:US
Practice Address - Phone:708-681-8802
Practice Address - Fax:708-681-8802
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional