Doctor Name: | REBECCA PEREHUDOFF MINTON |
NPI Number: | 1053722207 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, ATR, LCPC |
License Number: | 180.007090 |
Business Practice Address: | 4923 Main St Downers Grove, IL - 605153654 |
Business Phone Number: | 6302060272 |
Business Fax Number: | |
Mailing Address: | 6434 Waubansee Dr, LA GRANGE HIGHLANDS |
State: | IL |
Postal Code: | 605254365 |
Phone Number: | 7083638842 |
Fax Number: | |
NPI Enumeration Date: | 05/09/2014 |
NPI Last Update Date: | 11/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180.007090 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |