MEDICARE: EWING BLUE COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	101YM0800X	Mental Health Counselor
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1245996198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EWING BLUE COUNSELING PLLC

Provider Business Mailing Address
First Line	:	4509 N ILLINOIS ST STE 2
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-1524
Country	:	US
Telephone Number	:	618-702-9147
Fax Number	:	618-591-2952

Provider Business Practice Location Address
First Line	:	4509 N ILLINOIS ST STE 2
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-1524
Country	:	US
Telephone Number	:	618-702-9147
Fax Number	:	618-591-2952

Authorized Official
Title or Position	:	OWNER
Name	:	FELICIA K EWING
Credential	:	LCPC
Telephone Number	:	618-702-9147

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	06/26/2026

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