MEDICARE: BREATHE

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	101Y00000X	Counselor	180008522	IL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor	180008522	IL
4	102L00000X	Psychoanalyst	180008522	IL
5	106H00000X	Marriage & Family Therapist
6	251B00000X	Case Management Agency
7	251S00000X	Community/Behavioral Health Agency
8	305R00000X	Preferred Provider Organization
9	273R00000X	Psychiatric Hospital Unit
10	101YP2500X	Professional Counselor	180.008522	IL

General Provider Information

NPI Number	:	1285036491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATHE

Provider Business Mailing Address
First Line	:	329 W 102ND PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-1916
Country	:	US
Telephone Number	:	847-461-8718
Fax Number	:

Provider Business Practice Location Address
First Line	:	15255 S 94TH AVE
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-3800
Country	:	US
Telephone Number	:	847-461-8718
Fax Number	:	847-485-5605

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. WINIFRED BRADSHAW
Credential	:	CRC/LCPC
Telephone Number	:	847-461-8718

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	04/19/2016

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Directions to “BREATHE ” Practice Location

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