MEDICARE: PSYCHSOMATICA 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	:	1326774456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHSOMATICA PLLC

Provider Business Mailing Address
First Line	:	6107 N GLENWOOD AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-1894
Country	:	US
Telephone Number	:	615-347-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	6107 N GLENWOOD AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-1894
Country	:	US
Telephone Number	:	615-347-5656
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HOPE MARIE ENGLAND
Credential	:	LCPC
Telephone Number	:	615-347-5656

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	07/29/2022

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