Provider Demographics
NPI:1922343565
Name:WANTY, JOHN (LCPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WANTY
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 1:410 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 525, STUDIO 524
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1308
Mailing Address - Country:US
Mailing Address - Phone:773-492-1476
Mailing Address - Fax:
Practice Address - Street 1:410 S MICHIGAN AVE
Practice Address - Street 2:SUITE 525, STUDIO 524
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1308
Practice Address - Country:US
Practice Address - Phone:773-492-1476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-09
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional