MEDICARE: MS. JAMIE RACINE LAFEVERS 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	390200000X	Student in an Organized Health Care Education/Training Program	390200000X	IL
2	101YM0800X	Mental Health Counselor	180012245	IL

General Provider Information

NPI Number	:	1538444070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAMIE RACINE LAFEVERS LCPC

Provider Business Mailing Address
First Line	:	2311 N KIMBALL AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2431
Country	:	US
Telephone Number	:	312-736-2179
Fax Number	:

Provider Business Practice Location Address
First Line	:	2311 N KIMBALL AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2431
Country	:	US
Telephone Number	:	312-736-2179
Fax Number	:

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

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	03/08/2023

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