MEDICARE: AMBER PHELPS SCHWEDA LCPC

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	101Y00000X	Counselor	180.008725	IL
2	101YP2500X	Professional Counselor	180.008725	IL

General Provider Information

NPI Number	:	1326470121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER PHELPS SCHWEDA LCPC

Provider Business Mailing Address
First Line	:	4114 N WATER TOWER PLACE, SUITE C
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6295
Country	:	US
Telephone Number	:	618-244-0212
Fax Number	:	618-244-0535

Provider Business Practice Location Address
First Line	:	4114 N WATER TOWER PLACE, SUITE C
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6295
Country	:	US
Telephone Number	:	618-244-0212
Fax Number	:	618-244-0535

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

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	04/07/2015

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