MEDICARE: PBR FAMILY CONSULTING, INC.

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	1041C0700X	Clinical Social Worker	149001220	IL

General Provider Information

NPI Number	:	1306246566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PBR FAMILY CONSULTING, INC.

Provider Business Mailing Address
First Line	:	200 E EVERGREEN AVE STE 112
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-3240
Country	:	US
Telephone Number	:	847-255-4055
Fax Number	:	847-577-5066

Provider Business Practice Location Address
First Line	:	200 E EVERGREEN AVE STE 112
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-3240
Country	:	US
Telephone Number	:	847-255-4055
Fax Number	:	847-577-5066

Authorized Official
Title or Position	:	DIRECTOR/PSYCHOTHERAPIST
Name	:	PAULA B RANDANT
Credential	:	LCSW
Telephone Number	:	847-255-4055

Provider Enumeration Date	:	08/25/2014
Last Update Date	:	08/25/2014

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