MEDICARE: ELIZABETH ANN KIMURA MA, LPC, NCC, MT-BC

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	222Q00000X	Developmental Therapist
2	225A00000X	Music Therapist	11259	IL
3	101YP2500X	Professional Counselor	178018166	IL

General Provider Information

NPI Number	:	1851705123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN KIMURA MA, LPC, NCC, MT-BC

Provider Business Mailing Address
First Line	:	1455 W GREGORY ST APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1377
Country	:	US
Telephone Number	:	478-341-7993
Fax Number	:	815-788-1321

Provider Business Practice Location Address
First Line	:	1737 N CAMPBELL AVE UNIT 1S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5205
Country	:	US
Telephone Number	:	847-341-7993
Fax Number	:

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

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	06/27/2022

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