MEDICARE: NICHOLAS ANDREW KRYSZTOPIK 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	178.016826	IL

General Provider Information

NPI Number	:	1265082523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS ANDREW KRYSZTOPIK LPC

Provider Business Mailing Address
First Line	:	10537 S ROBERTS RD
Second Line	:
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-1933
Country	:	US
Telephone Number	:	708-974-5100
Fax Number	:	708-974-2498

Provider Business Practice Location Address
First Line	:	1457 N HALSTED ST UNIT B303
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-2677
Country	:	US
Telephone Number	:	773-977-4737
Fax Number	:	708-974-2498

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

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	11/08/2024

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