Provider Demographics
NPI:1306993522
Name:MJOEN, DREW M (MA, LCPC)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:M
Last Name:MJOEN
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 S MILWAUKEE AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3773
Mailing Address - Country:US
Mailing Address - Phone:847-557-0645
Mailing Address - Fax:847-557-9809
Practice Address - Street 1:1580 S MILWAUKEE AVE STE 307
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3773
Practice Address - Country:US
Practice Address - Phone:847-557-0645
Practice Address - Fax:847-557-9809
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional