MEDICARE: LAKESHORE COUNSELING GROUP, PLLC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1659833861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESHORE COUNSELING GROUP, PLLC

Provider Business Mailing Address
First Line	:	2001 N HALSTED ST STE 203
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4365
Country	:	US
Telephone Number	:	224-599-4777
Fax Number	:	224-366-2583

Provider Business Practice Location Address
First Line	:	2001 N HALSTED ST STE 203
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4365
Country	:	US
Telephone Number	:	224-599-4777
Fax Number	:	224-366-2583

Authorized Official
Title or Position	:	OWNER
Name	:	CATHERINE RANIERI
Credential	:	LCPC
Telephone Number	:	630-776-2230

Provider Enumeration Date	:	04/05/2019
Last Update Date	:	04/06/2023

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