MEDICARE: MR. JOSE MIGUEL VIRUET LCPC, CRADC

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	180008744	IL

General Provider Information

NPI Number	:	1578816294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE MIGUEL VIRUET LCPC, CRADC

Provider Business Mailing Address
First Line	:	4001 W DEVON AVE
Second Line	:	SUITE 211
City	:	CHICAGO
State	:	IL
Zip	:	60646-4523
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 W DEVON AVE
Second Line	:	SUITE 211
City	:	CHICAGO
State	:	IL
Zip	:	60646-4523
Country	:	US
Telephone Number	:	773-308-6992
Fax Number	:

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

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	07/14/2013

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