MEDICARE: ALIGN LIFE THERAPY, PLLC

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

General Provider Information

NPI Number	:	1063238988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALIGN LIFE THERAPY, PLLC

Provider Business Mailing Address
First Line	:	2150 E LAKE COOK RD FL 9
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1862
Country	:	US
Telephone Number	:	224-412-8327
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 E LAKE COOK RD FL 9
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1862
Country	:	US
Telephone Number	:	224-412-8327
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL PROFESSIONAL COUN
Name	:	AMANDA LAI WAI KUEN
Credential	:	MA
Telephone Number	:	224-412-8327

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	11/25/2024

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