MEDICARE: SABRA RACHELLE MAURICE LCPC

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	180-002810	IL

General Provider Information

NPI Number	:	1134138928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRA RACHELLE MAURICE LCPC

Provider Business Mailing Address
First Line	:	1989 TOUCAN WAY UNIT 103
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-5285
Country	:	US
Telephone Number	:	309-696-0993
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 GRANT RD
Second Line	:
City	:	MARQUETTE HEIGHTS
State	:	IL
Zip	:	61554-1227
Country	:	US
Telephone Number	:	309-696-0993
Fax Number	:

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	01/13/2024

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