Healthcare Provider Details

I. General information

NPI: 1801708003
Provider Name (Legal Business Name): AVERY POWELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W WASHINGTON ST STE 1500
CHICAGO IL
60602-3219
US

IV. Provider business mailing address

77 W WASHINGTON ST STE 1500
CHICAGO IL
60602-3219
US

V. Phone/Fax

Practice location:
  • Phone: 773-980-9679
  • Fax: 312-313-0625
Mailing address:
  • Phone: 773-980-9679
  • Fax: 312-313-0625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.033359
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: