MEDICARE: JAMIE LAFEVERS, LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1255098380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMIE LAFEVERS, LLC

Provider Business Mailing Address
First Line	:	2311 N KIMBALL AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2431
Country	:	US
Telephone Number	:	312-736-2179
Fax Number	:

Provider Business Practice Location Address
First Line	:	2311 N KIMBALL AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2431
Country	:	US
Telephone Number	:	312-736-2179
Fax Number	:	312-277-3122

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	JAMIE R LAFEVERS
Credential	:	LCPC
Telephone Number	:	312-736-2179

Provider Enumeration Date	:	11/23/2021
Last Update Date	:	03/08/2023

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