MEDICARE: CREE L CARTER

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	:	1356996284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CREE L CARTER

Provider Business Mailing Address
First Line	:	2671 SHERIDAN RD APT 301
Second Line	:
City	:	ZION
State	:	IL
Zip	:	60099-2684
Country	:	US
Telephone Number	:	256-457-4039
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 NATIONS DR STE 116
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-9171
Country	:	US
Telephone Number	:	847-245-6575
Fax Number	:

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

Provider Enumeration Date	:	08/07/2019
Last Update Date	:	08/07/2019

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Directions to “ CREE L CARTER ” Practice Location

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