MEDICARE: MR. PHILIPPUS BERNARDUS DE WET 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	180013050	IL

General Provider Information

NPI Number	:	1164948329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIPPUS BERNARDUS DE WET LCPC

Provider Business Mailing Address
First Line	:	1300 W BELMONT AVE STE 400F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3200
Country	:	US
Telephone Number	:	312-945-8651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 W BELMONT AVE STE 309
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3241
Country	:	US
Telephone Number	:	312-945-8651
Fax Number	:

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

Provider Enumeration Date	:	08/19/2017
Last Update Date	:	03/04/2026

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