MEDICARE: MS. PAMELA JUNE GOMEZ SCOTT LCPC, CADC

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	180006513	IL

General Provider Information

NPI Number	:	1245700517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA JUNE GOMEZ SCOTT LCPC, CADC

Provider Business Mailing Address
First Line	:	1 N DEARBORN ST STE 1000
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-4322
Country	:	US
Telephone Number	:	312-986-4119
Fax Number	:	312-986-4187

Provider Business Practice Location Address
First Line	:	1 N DEARBORN ST STE 1000
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-4322
Country	:	US
Telephone Number	:	312-986-4119
Fax Number	:	312-986-4187

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

Provider Enumeration Date	:	11/29/2018
Last Update Date	:	11/29/2018

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