MEDICARE: MRS. MARJORIE HELEN GARCIA LPC

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	178.004577	IL

General Provider Information

NPI Number	:	1164705315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARJORIE HELEN GARCIA LPC

Provider Business Mailing Address
First Line	:	1925 N CLYBOURN AVE
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60614-4946
Country	:	US
Telephone Number	:	773-305-5000
Fax Number	:	773-305-0739

Provider Business Practice Location Address
First Line	:	1925 N CLYBOURN AVE
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60614-4946
Country	:	US
Telephone Number	:	773-305-5000
Fax Number	:	773-305-0739

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

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	09/23/2011

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