| Doctor Name: | BENJAMIN WAUGHTAL |
| NPI Number: | 1528470507 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 178009075 |
| Business Practice Address: | 930 Il Route 22 Fox River Grove, IL - 600211905 |
| Business Phone Number: | 8478683435 |
| Business Fax Number: | |
| Mailing Address: | 175 E Hawthorn Pkwy, VERNON HILLS |
| State: | IL |
| Postal Code: | 600611463 |
| Phone Number: | 8478683435 |
| Fax Number: | |
| NPI Enumeration Date: | 05/27/2014 |
| NPI Last Update Date: | 05/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 178009075 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |