MEDICARE: COURTNEY K BERRY MA, 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	178.015796	IL
2	101YP2500X	Professional Counselor	180.015363	IL

General Provider Information

NPI Number	:	1134755416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY K BERRY MA, LCPC

Provider Business Mailing Address
First Line	:	400 PARK AVE APT 706
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5099
Country	:	US
Telephone Number	:	630-853-3181
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 PARK AVE APT 706
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5099
Country	:	US
Telephone Number	:	630-853-3181
Fax Number	:

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

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	07/17/2023

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