Provider Demographics
NPI:1053722207
Name:PEREHUDOFF MINTON, REBECCA (MA, ATR, LCPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:PEREHUDOFF MINTON
Suffix:
Gender:F
Credentials:MA, ATR, LCPC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:PEREHUDOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, ATR, LCPC
Mailing Address - Street 1:6434 WAUBANSEE DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4365
Mailing Address - Country:US
Mailing Address - Phone:708-363-8842
Mailing Address - Fax:
Practice Address - Street 1:4923 MAIN ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3654
Practice Address - Country:US
Practice Address - Phone:630-206-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007090101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional