MEDICARE: NORTHWEST SUBURBAN COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	101YP2500X	Professional Counselor
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1336535764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST SUBURBAN COUNSELING LLC

Provider Business Mailing Address
First Line	:	1800 E NORTHWEST HWY UNIT 4
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6944
Country	:	US
Telephone Number	:	800-922-0976
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 E NORTHWEST HWY UNIT 4
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6944
Country	:	US
Telephone Number	:	800-922-0976
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WHITNEY GIPSON
Credential	:	MSW, LMFT
Telephone Number	:	847-322-0756

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	04/05/2020

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