MEDICARE: ELIZABETH SAVAGE PSYCHOTHERAPY 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	180.008339	IL

General Provider Information

NPI Number	:	1104209618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH SAVAGE PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	1300 W BELMONT AVE
Second Line	:	SUITE 407
City	:	CHICAGO
State	:	IL
Zip	:	60657-3200
Country	:	US
Telephone Number	:	773-860-8779
Fax Number	:

Provider Business Practice Location Address
First Line	:	5210 N MAGNOLIA AVE
Second Line	:	APT. 3E
City	:	CHICAGO
State	:	IL
Zip	:	60640-2203
Country	:	US
Telephone Number	:	773-860-8779
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MS. ELIZABETH RACHAEL SAVAGE
Credential	:	LCPC
Telephone Number	:	773-860-8779

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	07/01/2015

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