Most Relevant Information
Provider Data
| NPI Number: | 1003595463 |
| Provider Name: | AMY TEVAULT MA, LPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 178.019198 |
Most Important Dates
| Enumeration Date: | 07/13/2023 |
| Last Updated: | 07/13/2023 |
Provider Practice Location
303 E WACKER DR STE 1130
CHICAGO
IL
606015227
Practice Location Phone/Fax
| Phone: | 3126003935 |
| Fax: |
Provider Mailing Location
303 E WACKER DR
CHICAGO
IL
606015212
Provider Mailing Phone/Fax
| Phone: | 3126003935 |
| Fax: |