MEDICARE: MS. ELIZABETH BRITT RAPHLING LCPC

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	101YM0800X	Mental Health Counselor	180007527	IL

General Provider Information

NPI Number	:	1730492158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH BRITT RAPHLING LCPC

Provider Business Mailing Address
First Line	:	3322 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-0195
Country	:	US
Telephone Number	:	773-506-4463
Fax Number	:	773-525-3325

Provider Business Practice Location Address
First Line	:	3322 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-0195
Country	:	US
Telephone Number	:	773-506-4463
Fax Number	:	773-525-3325

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2010
Last Update Date	:	07/15/2010

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