Provider Demographics
NPI:1740163401
Name:AMEGAN, YAO GAUTIER (MA, LPC)
Entity type:Individual
Prefix:
First Name:YAO
Middle Name:GAUTIER
Last Name:AMEGAN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10479 DEARLOVE RD APT 2A
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3516
Mailing Address - Country:US
Mailing Address - Phone:360-508-4035
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 1615
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3722
Practice Address - Country:US
Practice Address - Phone:773-234-6581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.021890101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health