MEDICARE: THE FELONY FREE SOCIETY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	1041C0700X	Clinical Social Worker
4	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1184458291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FELONY FREE SOCIETY

Provider Business Mailing Address
First Line	:	3247 LOUISE DR # 0
Second Line	:
City	:	LANSING
State	:	IL
Zip	:	60438-3607
Country	:	US
Telephone Number	:	773-530-9492
Fax Number	:

Provider Business Practice Location Address
First Line	:	4455 S KING DR STE 101B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3310
Country	:	US
Telephone Number	:	773-696-6181
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DALTON BROWN
Credential	:
Telephone Number	:	773-696-6181

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	08/29/2024

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Directions to “THE FELONY FREE SOCIETY ” Practice Location

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