MEDICARE: EMBRACE THE CENTER FOR EMOTIONAL WELLBEING 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	103T00000X	Psychologist	071009049	IL

General Provider Information

NPI Number	:	1013457951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBRACE THE CENTER FOR EMOTIONAL WELLBEING LLC

Provider Business Mailing Address
First Line	:	4305 N LINCOLN AVE
Second Line	:	STE M
City	:	CHICAGO
State	:	IL
Zip	:	60618-1807
Country	:	US
Telephone Number	:	824-216-7793
Fax Number	:	855-727-4855

Provider Business Practice Location Address
First Line	:	4305 N LINCOLN AVE
Second Line	:	STE M
City	:	CHICAGO
State	:	IL
Zip	:	60618-1807
Country	:	US
Telephone Number	:	824-216-7793
Fax Number	:	855-727-4855

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA STEBBINS
Credential	:	PSYD
Telephone Number	:	827-216-7793

Provider Enumeration Date	:	02/25/2017
Last Update Date	:	02/25/2017

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