Provider Demographics
NPI:1871860783
Name:TRYTEK VAGUE, JULIE (MA, LCPC, CADC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:TRYTEK VAGUE
Suffix:
Gender:F
Credentials:MA, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 LONGFORD CIR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-4829
Mailing Address - Country:US
Mailing Address - Phone:708-837-3701
Mailing Address - Fax:
Practice Address - Street 1:1211 LONGFORD CIR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4829
Practice Address - Country:US
Practice Address - Phone:708-837-3701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-20
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional