MEDICARE: MRS. PATRICIA BORELA JONES 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	178010372	IL
2	101YM0800X	Mental Health Counselor	180011920	IL
3	101YP2500X	Professional Counselor	178010372	IL
4	101YP2500X	Professional Counselor	180011920	IL

General Provider Information

NPI Number	:	1881132991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA BORELA JONES LCPC

Provider Business Mailing Address
First Line	:	924 W 75TH ST STE 120-122
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-6193
Country	:	US
Telephone Number	:	224-600-5466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 N WASHINGTON ST STE 120
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-2767
Country	:	US
Telephone Number	:	224-600-5466
Fax Number	:

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

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	02/27/2023

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