MEDICARE: MR. PERRY J CALHOUN LPC

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	101Y00000X	Counselor	178006161	IL

General Provider Information

NPI Number	:	1235415621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PERRY J CALHOUN LPC

Provider Business Mailing Address
First Line	:	2343 177TH ST
Second Line	:
City	:	LANSING
State	:	IL
Zip	:	60438-1722
Country	:	US
Telephone Number	:	773-720-6199
Fax Number	:	708-585-6222

Provider Business Practice Location Address
First Line	:	3017 E 78TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-5395
Country	:	US
Telephone Number	:	708-474-6603
Fax Number	:

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

Provider Enumeration Date	:	10/29/2011
Last Update Date	:	12/16/2015

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