MEDICARE: ELIZABETH G HELLSTROM C.L.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	101YM0800X	Mental Health Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1952637357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH G HELLSTROM C.L.

Provider Business Mailing Address
First Line	:	3923 CHESTER BLVD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1085
Country	:	US
Telephone Number	:	765-962-0521
Fax Number	:

Provider Business Practice Location Address
First Line	:	3923 CHESTER BLVD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1085
Country	:	US
Telephone Number	:	765-962-0521
Fax Number	:

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

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	12/08/2011

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