Provider Demographics
NPI:1770821373
Name:AGIN, EVE COOPER
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:COOPER
Last Name:AGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCSW
Mailing Address - Street 1:151 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 2119
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7506
Mailing Address - Country:US
Mailing Address - Phone:312-729-5432
Mailing Address - Fax:
Practice Address - Street 1:1866 SHERIDAN ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:312-729-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149004494101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional