MEDICARE: NEXT LEVEL 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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1750614053	OTHER	IL	NPI SOLO PRACTITIONER

General Provider Information

NPI Number	:	1104398767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXT LEVEL COUNSELING LLC

Provider Business Mailing Address
First Line	:	822 W AGATITE AVE # 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-6102
Country	:	US
Telephone Number	:	312-505-8134
Fax Number	:	773-654-1370

Provider Business Practice Location Address
First Line	:	180 N MICHIGAN AVE STE 2410
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7471
Country	:	US
Telephone Number	:
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL ALLEN KOBOSKY
Credential	:	LCSW
Telephone Number	:	312-505-8134

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	12/20/2018

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