MEDICARE: SEJAL PAREKH MAMFT

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1225342470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEJAL PAREKH MAMFT

Provider Business Mailing Address
First Line	:	10936 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-2220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 W SHERWIN AVE
Second Line	:	#311
City	:	CHICAGO
State	:	IL
Zip	:	60626-2263
Country	:	US
Telephone Number	:	843-319-3042
Fax Number	:

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

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/29/2010

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