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NPI Code Detail

MEDICARE: SCE PSYCHOTHERAPY

MEDICARE: SCE PSYCHOTHERAPY
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1194484980
Entity Type Code : Organization
Provider Name (Legal Business Name) : SCE PSYCHOTHERAPY
Provider Business Mailing Address
First Line : 3208 N HALSTED ST APT 2
Second Line :
City : CHICAGO
State : IL
Zip : 60657-3414
Country : US
Telephone Number : 773-615-0958
Fax Number :
Provider Business Practice Location Address
First Line : 3208 N HALSTED ST APT 2
Second Line :
City : CHICAGO
State : IL
Zip : 60657-3414
Country : US
Telephone Number : 773-615-0958
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SHANNON ELIZABETH
Credential : LCPC
Telephone Number : 773-615-0958
Provider Enumeration Date : 12/09/2021
Last Update Date : 12/09/2021

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Directions to “SCE PSYCHOTHERAPY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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