MEDICARE: ADAM ROBINSON LCPC

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	101YP2500X	Professional Counselor	180007034	IL

General Provider Information

NPI Number	:	1366684235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM ROBINSON LCPC

Provider Business Mailing Address
First Line	:	PO BOX 764
Second Line	:
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-0764
Country	:	US
Telephone Number	:	847-265-7300
Fax Number	:	847-265-7301

Provider Business Practice Location Address
First Line	:	137 CEDAR AVE
Second Line	:
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-8410
Country	:	US
Telephone Number	:	847-265-7300
Fax Number	:	847-265-7301

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

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	03/24/2009

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