MEDICARE: TERI CICUREL

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	178.01.4275	IL
2	101YM0800X	Mental Health Counselor	180.013386	IL

General Provider Information

NPI Number	:	1275007486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI CICUREL

Provider Business Mailing Address
First Line	:	9 W WALTON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-7324
Country	:	US
Telephone Number	:	773-230-2025
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E WASHINGTON ST STE 1458
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1856
Country	:	US
Telephone Number	:	312-476-9159
Fax Number	:

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

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	03/11/2021

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Directions to “ TERI CICUREL ” Practice Location

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