MEDICARE: LIFE SOLUTIONS COUNSELING SERVICES

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033749106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE SOLUTIONS COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	4608 W 99TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-3134
Country	:	US
Telephone Number	:	773-573-3206
Fax Number	:

Provider Business Practice Location Address
First Line	:	7330 W COLLEGE DR STE 207
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1157
Country	:	US
Telephone Number	:	708-568-1479
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MR. JAMES PHELAN
Credential	:	LCPC
Telephone Number	:	773-573-3206

Provider Enumeration Date	:	01/17/2020
Last Update Date	:	01/17/2020

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