MEDICARE: CANDACE LIPP 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		IL

General Provider Information

NPI Number	:	1194831297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE LIPP LCPC

Provider Business Mailing Address
First Line	:	14117 YORKTOWN DR
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-2124
Country	:	US
Telephone Number	:	773-365-7277
Fax Number	:	773-365-3093

Provider Business Practice Location Address
First Line	:	2542 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5216
Country	:	US
Telephone Number	:	773-365-7277
Fax Number	:	773-365-3093

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	12/12/2007

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