MEDICARE: MRS. CAROLINE KELLY TYE LCPC, ATR-BC

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	180011239	IL
2	101YP2500X	Professional Counselor	178012176	IL
3	221700000X	Art Therapist	16-069	IL

General Provider Information

NPI Number	:	1245787506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLINE KELLY TYE LCPC, ATR-BC

Provider Business Mailing Address
First Line	:	6528 N GREENVIEW AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-5008
Country	:	US
Telephone Number	:	847-651-8643
Fax Number	:

Provider Business Practice Location Address
First Line	:	1628 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1214
Country	:	US
Telephone Number	:	847-651-8643
Fax Number	:

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

Provider Enumeration Date	:	09/04/2016
Last Update Date	:	06/18/2026

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