MEDICARE: JULIAN MARK WILLIAMS LCPC LICENSED CLINIC

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	103T00000X	Psychologist		IL

General Provider Information

NPI Number	:	1225102429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIAN MARK WILLIAMS LCPC LICENSED CLINIC

Provider Business Mailing Address
First Line	:	4808 NORTH LINDER AVE
Second Line	:	STE LB
City	:	CHICAGO
State	:	IL
Zip	:	60630
Country	:	US
Telephone Number	:	773-416-5705
Fax Number	:

Provider Business Practice Location Address
First Line	:	4808 NORTH LINDER AVE
Second Line	:	STE LB
City	:	CHICAGO
State	:	IL
Zip	:	60630
Country	:	US
Telephone Number	:	773-416-5705
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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