Provider Demographics
NPI:1215078266
Name:COON, CAROL A (LCPC)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:COON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W OGDEN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3179
Mailing Address - Country:US
Mailing Address - Phone:630-653-7339
Mailing Address - Fax:630-986-1477
Practice Address - Street 1:501 W OGDEN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3179
Practice Address - Country:US
Practice Address - Phone:630-653-7339
Practice Address - Fax:630-986-1477
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health