Provider Demographics
NPI:1063156545
Name:MENGES, BETH MARIE (LCPC, CADC)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:MARIE
Last Name:MENGES
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:MARIE
Other - Last Name:SACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, CADC
Mailing Address - Street 1:1335 N MILL ST STE 280
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2262
Mailing Address - Country:US
Mailing Address - Phone:630-646-5107
Mailing Address - Fax:
Practice Address - Street 1:1335 N MILL ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2261
Practice Address - Country:US
Practice Address - Phone:630-646-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002548101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional