MEDICARE: MRS. ERYN LYN APPLE

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	:	1336585728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERYN LYN APPLE

Provider Business Mailing Address
First Line	:	2310 W ROOSEVELT RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1131
Country	:	US
Telephone Number	:	312-566-4527
Fax Number	:	312-236-5384

Provider Business Practice Location Address
First Line	:	2310 W ROOSEVELT RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1131
Country	:	US
Telephone Number	:	312-566-4527
Fax Number	:	312-236-5384

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2013
Last Update Date	:	06/21/2016

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