MEDICARE: CHICAGO COUNSELING ASSOCIATES

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	101YM0800X	Mental Health Counselor	178-000596	IL
2	106H00000X	Marriage & Family Therapist	178-007170	IL
3	101YM0800X	Mental Health Counselor	180-001970	IL

General Provider Information

NPI Number	:	1215299987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO COUNSELING ASSOCIATES

Provider Business Mailing Address
First Line	:	1000 W DIVERSEY PKWY STE 275
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1879
Country	:	US
Telephone Number	:	773-281-7200
Fax Number	:	773-281-7201

Provider Business Practice Location Address
First Line	:	1000 W DIVERSEY PKWY STE 275
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1879
Country	:	US
Telephone Number	:	773-281-7200
Fax Number	:	773-281-7201

Authorized Official
Title or Position	:	DIRECTOR / OWNER
Name	:	CAROLYN SCHNEIDER
Credential	:	M.A.
Telephone Number	:	773-281-7200

Provider Enumeration Date	:	06/08/2012
Last Update Date	:	09/24/2019

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