MEDICARE: AMARIS COUNSELING LLC

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	:	1992394514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMARIS COUNSELING LLC

Provider Business Mailing Address
First Line	:	2528 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-1303
Country	:	US
Telephone Number	:	773-595-2778
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 W MAPLE ST
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-3043
Country	:	US
Telephone Number	:	773-234-4214
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RACHAEL STEWART
Credential	:	LCSW
Telephone Number	:	773-595-2778

Provider Enumeration Date	:	01/18/2021
Last Update Date	:	01/18/2021

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