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NPI Code Detail

MEDICARE: MANYA TUTEJA MA, LPC

MEDICARE: MANYA TUTEJA MA, LPC
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
1101YM0800XMental Health Counselor178.022348IL

General Provider Information

NPI Number : 1144185828
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANYA TUTEJA MA, LPC
Provider Business Mailing Address
First Line : 3209 N LAKEWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-3215
Country : US
Telephone Number : 872-274-4344
Fax Number : 866-671-9991
Provider Business Practice Location Address
First Line : 3209 N LAKEWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-3215
Country : US
Telephone Number : 872-274-4344
Fax Number : 866-671-9991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2025
Last Update Date : 12/16/2025

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