=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578766812
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIK MICHAEL LEVINSON LCPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2007
-----------------------------------------------------
Last Update Date | 03/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1431 N CLAREMONT AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60622-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-531-6225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5445 N SHERIDAN RD #3111
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60640-1957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-531-6225
-----------------------------------------------------
Fax | 773-728-7668
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180006537
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------