Provider Demographics
NPI:1750539508
Name:PETERSON, DAN CHAD (LCPC)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:CHAD
Last Name:PETERSON
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:IL
Mailing Address - Zip Code:60512-9711
Mailing Address - Country:US
Mailing Address - Phone:630-420-2596
Mailing Address - Fax:630-420-2597
Practice Address - Street 1:445 W JACKSON AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5256
Practice Address - Country:US
Practice Address - Phone:630-420-2596
Practice Address - Fax:630-420-2597
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005898101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional