MEDICARE: ERIN J AUSTIN LCPC

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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	180.008593	IL

General Provider Information

NPI Number	:	1013114875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN J AUSTIN LCPC

Provider Business Mailing Address
First Line	:	5N443 SANTA FE TRL
Second Line	:
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-2411
Country	:	US
Telephone Number	:	630-465-3374
Fax Number	:

Provider Business Practice Location Address
First Line	:	5N443 SANTA FE TRL
Second Line	:
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-2411
Country	:	US
Telephone Number	:	630-465-3374
Fax Number	:

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	06/06/2013

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