MEDICARE: RALIAT Q ADEBOYEJO M.A, 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	101YM0800X	Mental Health Counselor	178.012231	IL
2	101YP2500X	Professional Counselor	180.011680

General Provider Information

NPI Number	:	1093266090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALIAT Q ADEBOYEJO M.A, LCPC

Provider Business Mailing Address
First Line	:	155 N MICHIGAN AVE STE 561
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7799
Country	:	US
Telephone Number	:	872-267-0339
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 N MICHIGAN AVE STE 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7940
Country	:	US
Telephone Number	:	312-722-6487
Fax Number	:

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

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	07/08/2021

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