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NPI Code Detail

MEDICARE: CARLYN R WILLIAMS MA, LCPC

MEDICARE: CARLYN R WILLIAMS MA, 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
1101YP2500XProfessional Counselor178.015415IL
2101YP2500XProfessional Counselor180013978IL

General Provider Information

NPI Number : 1770121576
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLYN R WILLIAMS MA, LCPC
Provider Business Mailing Address
First Line : 1860 W WINCHESTER RD STE 205
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-5317
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1860 W WINCHESTER RD STE 205
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-5317
Country : US
Telephone Number : 224-424-4194
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2019
Last Update Date : 11/08/2021

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