MEDICARE: DIMITRA ILIOPOULOS 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	101YP2500X	Professional Counselor	180.015283	IL

General Provider Information

NPI Number	:	1033890025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIMITRA ILIOPOULOS LCPC

Provider Business Mailing Address
First Line	:	11248 S NATOMA AVE
Second Line	:
City	:	WORTH
State	:	IL
Zip	:	60482-1904
Country	:	US
Telephone Number	:	708-717-8105
Fax Number	:

Provider Business Practice Location Address
First Line	:	11248 S NATOMA AVE
Second Line	:
City	:	WORTH
State	:	IL
Zip	:	60482-1904
Country	:	US
Telephone Number	:	708-717-8105
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	07/31/2023

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Directions to “ DIMITRA ILIOPOULOS LCPC” Practice Location

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