MEDICARE: CYNTHIA LYNN MESMER M.A., 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	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1407042088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LYNN MESMER M.A., LCPC

Provider Business Mailing Address
First Line	:	900 PYOTT RD
Second Line	:	SUITE 102
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8716
Country	:	US
Telephone Number	:	815-444-9076
Fax Number	:	815-444-9079

Provider Business Practice Location Address
First Line	:	900 PYOTT RD
Second Line	:	SUITE 102
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8716
Country	:	US
Telephone Number	:	815-444-9076
Fax Number	:	815-444-9079

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

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	09/18/2007

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