MEDICARE: MATRESCENCE THERAPY

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

General Provider Information

NPI Number	:	1992393888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATRESCENCE THERAPY

Provider Business Mailing Address
First Line	:	2543 N GREENVIEW AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2028
Country	:	US
Telephone Number	:	847-436-8878
Fax Number	:

Provider Business Practice Location Address
First Line	:	2543 N GREENVIEW AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2028
Country	:	US
Telephone Number	:	847-436-8878
Fax Number	:

Authorized Official
Title or Position	:	OWNER, THERAPIST
Name	:	LAUREN RATLIFF
Credential	:	LCSW
Telephone Number	:	847-436-8878

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/06/2021

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Directions to “MATRESCENCE THERAPY ” Practice Location

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