MEDICARE: COUNSELING CENTER FOR EMOTIONAL GROWTH CORP.

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
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1295004018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING CENTER FOR EMOTIONAL GROWTH CORP.

Provider Business Mailing Address
First Line	:	3660 N. LAKE SHORE DRIVE, UNIT 3010
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5314
Country	:	US
Telephone Number	:	708-373-1952
Fax Number	:	312-643-1341

Provider Business Practice Location Address
First Line	:	3660 N. LAKE SHORE DRIVE, UNIT 3010
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5314
Country	:	US
Telephone Number	:	708-373-1952
Fax Number	:	312-643-1341

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	MS. GEORGETTE ELAIINE LEPAGE
Credential	:	MS, LCPC
Telephone Number	:	847-967-0952

Provider Enumeration Date	:	12/22/2011
Last Update Date	:	12/04/2024

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