MEDICARE: GREAT HEIGHTS PROFESSIONAL SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor
3	101Y00000X	Counselor

General Provider Information

NPI Number	:	1639301518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT HEIGHTS PROFESSIONAL SERVICES INC

Provider Business Mailing Address
First Line	:	1459 RING RD
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5459
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1459 RING RD
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5459
Country	:	US
Telephone Number	:	708-868-1751
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. OLUBUKUNOLA ONI
Credential	:
Telephone Number	:	708-868-1751

Provider Enumeration Date	:	08/11/2009
Last Update Date	:	08/11/2009

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