MEDICARE: PAZ INTERIOR COUNSELING, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1073127965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAZ INTERIOR COUNSELING, LLC

Provider Business Mailing Address
First Line	:	3058 W BELMONT AVE STE 1A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5707
Country	:	US
Telephone Number	:	708-692-4002
Fax Number	:

Provider Business Practice Location Address
First Line	:	3058 W BELMONT AVE STE 1A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5707
Country	:	US
Telephone Number	:	708-692-4002
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST/CLINICIAN
Name	:	MARIA G PEREZ
Credential	:	LCSW
Telephone Number	:	708-692-4002

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	09/08/2020

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