MEDICARE: MR. RICHARD WILLIAM SCHUPNER M.A.

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	180-000397	IL

General Provider Information

NPI Number	:	1104078096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD WILLIAM SCHUPNER M.A.

Provider Business Mailing Address
First Line	:	5419 BULL VALLEY RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-7410
Country	:	US
Telephone Number	:	815-578-0115
Fax Number	:

Provider Business Practice Location Address
First Line	:	5419 BULL VALLEY RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-7410
Country	:	US
Telephone Number	:	815-578-0115
Fax Number	:

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

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	10/22/2008

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