MEDICARE: THE AGENCY AGENCY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1023996790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE AGENCY AGENCY PLLC

Provider Business Mailing Address
First Line	:	2109 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3923
Country	:	US
Telephone Number	:	773-270-1233
Fax Number	:

Provider Business Practice Location Address
First Line	:	2109 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3923
Country	:	US
Telephone Number	:	773-270-1233
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ISAAC WILLIAM SAMUELSON
Credential	:	LCPC
Telephone Number	:	773-270-1233

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	09/23/2025

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