MEDICARE: PURPOSEFUL LIVING COUNSELING SERVICES 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	251S00000X	Community/Behavioral Health Agency	149017681	IL

General Provider Information

NPI Number	:	1114379294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURPOSEFUL LIVING COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	2431 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3713
Country	:	US
Telephone Number	:	773-759-7932
Fax Number	:

Provider Business Practice Location Address
First Line	:	2431 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3713
Country	:	US
Telephone Number	:	773-759-7932
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MRS. SHARONSLABA DAVILA
Credential	:	LCSW
Telephone Number	:	773-759-7932

Provider Enumeration Date	:	07/12/2016
Last Update Date	:	07/12/2016

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