Provider Demographics
NPI:1700934213
Name:PETERS, CYNTHIA YOUNG (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:YOUNG
Last Name:PETERS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NORTH SHORE DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2243
Mailing Address - Country:US
Mailing Address - Phone:224-365-4067
Mailing Address - Fax:866-861-2168
Practice Address - Street 1:900 NORTH SHORE DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2243
Practice Address - Country:US
Practice Address - Phone:224-365-4067
Practice Address - Fax:866-861-2168
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000805106H00000X
TX201094106H00000X
TX62355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional