MEDICARE: WILLOW AND IVY COUNSELING, PLLC

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	:	1295695146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW AND IVY COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	2501 CHATHAM RD STE 6113
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4188
Country	:	US
Telephone Number	:	269-876-9671
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 N DAYTON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-5002
Country	:	US
Telephone Number	:	269-876-9671
Fax Number	:

Authorized Official
Title or Position	:	OWNER, MENTAL HEALTH THERAPIST
Name	:	ELIZABETH TYRPAK
Credential	:	LCPC
Telephone Number	:	269-876-9671

Provider Enumeration Date	:	11/13/2025
Last Update Date	:	11/13/2025

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