MEDICARE: TOTAL ENRICHMENT SERVICES INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	171M00000X	Case Manager/Care Coordinator
4	2084P0800X	Psychiatry Physician
5	225C00000X	Rehabilitation Counselor
6	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	IL

General Provider Information

NPI Number	:	1821487646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL ENRICHMENT SERVICES INC.

Provider Business Mailing Address
First Line	:	3335 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-2454
Country	:	US
Telephone Number	:	773-403-1162
Fax Number	:

Provider Business Practice Location Address
First Line	:	3335 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624
Country	:	US
Telephone Number	:	773-403-1162
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. CORA LEE MONTOGOMERY
Credential	:	M.S.
Telephone Number	:	773-403-1162

Provider Enumeration Date	:	01/16/2015
Last Update Date	:	04/19/2021

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