Individual
CHARLES S MIYAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
REV.; LPC
Contact information
Practice address
1427 CHICAGO AVE, EVANSTON, IL 60201-4726
(847) 864-9133
Mailing address
1427 CHICAGO AVE, EVANSTON, IL 60201-4726
(847) 864-9133
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
178.008311
IL
Other
Enumeration date
06/06/2013
Last updated
10/21/2013
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