MEDICARE: ALPHA COUNSELING CENTER INC

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9932149	OTHER	IL	BLUECROSSBLUESHIELD OF IL

General Provider Information

NPI Number	:	1861572240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA COUNSELING CENTER INC

Provider Business Mailing Address
First Line	:	1112 S WASHINGTON ST
Second Line	:	SUITE 14
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-7999
Country	:	US
Telephone Number	:	630-983-4577
Fax Number	:	630-983-4690

Provider Business Practice Location Address
First Line	:	1112 S WASHINGTON ST
Second Line	:	SUITE 14
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-7999
Country	:	US
Telephone Number	:	630-983-4577
Fax Number	:	630-983-4690

Authorized Official
Title or Position	:	THERAPIST OWNER
Name	:	MS. MARY ANN KULLMAN
Credential	:	MS LCPC
Telephone Number	:	630-983-4577

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/22/2020

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