MEDICARE: TANYA PASHKULEVA

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	101YM0800X	Mental Health Counselor	178.020041	IL

General Provider Information

NPI Number	:	1467208827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA PASHKULEVA

Provider Business Mailing Address
First Line	:	1958 W AINSLIE ST APT 3B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3316
Country	:	US
Telephone Number	:	773-495-5131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1958 W AINSLIE ST APT 3B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3316
Country	:	US
Telephone Number	:	773-495-5131
Fax Number	:

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

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	04/26/2024

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Directions to “ TANYA PASHKULEVA ” Practice Location

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