MEDICARE: CAREY COUNSELING

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023643780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREY COUNSELING

Provider Business Mailing Address
First Line	:	5149 ROWENA DR
Second Line	:
City	:	ROSCOE
State	:	IL
Zip	:	61073-9407
Country	:	US
Telephone Number	:	815-703-7542
Fax Number	:	815-977-5929

Provider Business Practice Location Address
First Line	:	5301 E STATE ST STE 202
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2392
Country	:	US
Telephone Number	:	815-703-7542
Fax Number	:	815-977-5929

Authorized Official
Title or Position	:	OWNER
Name	:	MS. STEPHANIE ANNE CAREY
Credential	:	LCPC
Telephone Number	:	815-703-7542

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	03/03/2020

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Directions to “CAREY COUNSELING ” Practice Location

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