Provider Demographics
NPI:1053609289
Name:CHUNG, BETH (MS)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 N. MILWAUKEE AVE
Mailing Address - Street 2:SUITE B, UNIT 218
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4803 N. MILWAUKEE AVE
Practice Address - Street 2:SUITE B, UNIT 218
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1563
Practice Address - Country:US
Practice Address - Phone:773-318-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist