Provider Demographics
NPI:1760669477
Name:PUGAL, DEMETRA (LCPC)
Entity Type:Individual
Prefix:
First Name:DEMETRA
Middle Name:
Last Name:PUGAL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:TOULA
Other - Middle Name:
Other - Last Name:TRAKAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1035 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2953
Mailing Address - Country:US
Mailing Address - Phone:847-372-2559
Mailing Address - Fax:847-730-3875
Practice Address - Street 1:4660 THORNBARK DR
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-1157
Practice Address - Country:US
Practice Address - Phone:847-372-2559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional