MEDICARE: COUNTERPOINT PSYCHOTHERAPY LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1538841978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTERPOINT PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	5412 N CLARK ST STE 227
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1273
Country	:	US
Telephone Number	:	312-451-1207
Fax Number	:

Provider Business Practice Location Address
First Line	:	5412 N CLARK ST STE 227
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1273
Country	:	US
Telephone Number	:	312-451-1207
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ADAM EDWARD NELSON
Credential	:	LCSW
Telephone Number	:	312-451-1207

Provider Enumeration Date	:	08/04/2023
Last Update Date	:	08/04/2023

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