MEDICARE: LAMONT T BROWN TAYLOR

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	101Y00000X	Counselor	149-011481	IL
2	101YM0800X	Mental Health Counselor	149-011481	IL
3	104100000X	Social Worker	149-011481	IL
4	1041C0700X	Clinical Social Worker	149-011481	IL

General Provider Information

NPI Number	:	1720262991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAMONT T BROWN TAYLOR

Provider Business Mailing Address
First Line	:	PO BOX 490645
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-0645
Country	:	US
Telephone Number	:	773-509-5055
Fax Number	:	773-509-5010

Provider Business Practice Location Address
First Line	:	10540 S WESTERN AVE
Second Line	:	SUITE 402
City	:	CHICAGO
State	:	IL
Zip	:	60643-2529
Country	:	US
Telephone Number	:	773-509-5055
Fax Number	:	773-509-5010

Authorized Official
Title or Position	:	LICENSE CLINICAL SOCIAL WORKER
Name	:	DR. LAMONT THEOLONUS TAYLOR
Credential	:	DSW
Telephone Number	:	773-509-5055

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	10/28/2016

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