MEDICARE: HEALTHY MIND & LIFE COUNSELING CENTER

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

General Provider Information

NPI Number	:	1598381188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY MIND & LIFE COUNSELING CENTER

Provider Business Mailing Address
First Line	:	3047 W CERMAK RD FL 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3421
Country	:	US
Telephone Number	:	312-318-1022
Fax Number	:

Provider Business Practice Location Address
First Line	:	3047 W CERMAK RD FL 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3421
Country	:	US
Telephone Number	:	312-318-1022
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	ESTELA MELGOZA
Credential	:	PHD
Telephone Number	:	773-455-5173

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	06/19/2020

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