MEDICARE: MR. DANIEL M. BADER LCPC, LMFT

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	180-002045	IL
2	106H00000X	Marriage & Family Therapist	166-000437	IL

General Provider Information

NPI Number	:	1194037788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL M. BADER LCPC, LMFT

Provider Business Mailing Address
First Line	:	1607 W HOWARD ST
Second Line	:	THIRD FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60626-1675
Country	:	US
Telephone Number	:	312-742-1742
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 W HOWARD ST
Second Line	:	THIRD FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60626-1675
Country	:	US
Telephone Number	:	312-742-1742
Fax Number	:

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

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	07/12/2010

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