MEDICARE: CAMILLE ELIZABETH ANDRESS LPC

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	101Y00000X	Counselor	178.011434	IL

General Provider Information

NPI Number	:	1346612389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE ELIZABETH ANDRESS LPC

Provider Business Mailing Address
First Line	:	318 W HALF DAY RD
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-6547
Country	:	US
Telephone Number	:	847-821-9346
Fax Number	:

Provider Business Practice Location Address
First Line	:	34121 N US HIGHWAY 45
Second Line	:	SUITE 221
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-1768
Country	:	US
Telephone Number	:	872-588-0912
Fax Number	:

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

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	10/29/2015

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