MEDICARE: MAYRA GUADALUPE JARAMILLO

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	:	1104758721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRA GUADALUPE JARAMILLO

Provider Business Mailing Address
First Line	:	414 NORTHSHORE DR
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-2620
Country	:	US
Telephone Number	:	872-226-9770
Fax Number	:

Provider Business Practice Location Address
First Line	:	6321 N AVONDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-1900
Country	:	US
Telephone Number	:	773-774-4444
Fax Number	:

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

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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