MEDICARE: MS. DIANE LYNN LEVY 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	101YM0800X	Mental Health Counselor	180.007709	IL

General Provider Information

NPI Number	:	1497192033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE LYNN LEVY LCPC

Provider Business Mailing Address
First Line	:	3122 N DANIELS CT
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1508
Country	:	US
Telephone Number	:	708-217-1348
Fax Number	:

Provider Business Practice Location Address
First Line	:	3122 N DANIELS CT
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1508
Country	:	US
Telephone Number	:	708-217-1348
Fax Number	:

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

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	03/16/2016

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