MEDICARE: EQ COUNSELING AND WELLNESS

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1316882293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EQ COUNSELING AND WELLNESS

Provider Business Mailing Address
First Line	:	192 N WELLS ST # 3009
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-1848
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4018 S MICHIGAN AVE #4F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653
Country	:	US
Telephone Number	:	219-688-0014
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER/ CEO
Name	:	MR. KEENEN ELLIOT STEVENSON
Credential	:	LCSW
Telephone Number	:	219-688-0014

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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