Provider Demographics
NPI:1417645987
Name:PROCTOR, SAMANTHA (LCPC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:PROCTOR
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:KOVAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC/LCPC
Mailing Address - Street 1:5151 MOCHEL DR STE 307
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5078
Mailing Address - Country:US
Mailing Address - Phone:630-963-5390
Mailing Address - Fax:630-852-2841
Practice Address - Street 1:5151 MOCHEL DR STE 307
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5078
Practice Address - Country:US
Practice Address - Phone:630-963-5390
Practice Address - Fax:630-852-2841
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019041101YP2500X
IL180.016804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional