MEDICARE: RISA LYNETTE BECKER

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	101YP2500X	Professional Counselor	178.015656	IL

General Provider Information

NPI Number	:	1083230007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RISA LYNETTE BECKER

Provider Business Mailing Address
First Line	:	61 S OLD RAND RD
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-3127
Country	:	US
Telephone Number	:	847-438-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	5435 BULL VALLEY RD STE 230
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-7435
Country	:	US
Telephone Number	:	847-438-4222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2020
Last Update Date	:	06/25/2020

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Directions to “ RISA LYNETTE BECKER ” Practice Location

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