MEDICARE: NUPATH TO WELLNESS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QX0200X	Oncology Clinic/Center
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700656550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUPATH TO WELLNESS

Provider Business Mailing Address
First Line	:	2611 S INDIANA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2611 S INDIANA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2326
Country	:	US
Telephone Number	:	708-829-7939
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	LORETTA T SUMERSET-YOUNG
Credential	:
Telephone Number	:	708-829-7939

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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Directions to “NUPATH TO WELLNESS ” Practice Location

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