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NPI Code Detail

MEDICARE: MARIA MOLINA LCPC

MEDICARE: MARIA MOLINA 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
1101YP2500XProfessional Counselor180.007533IL

General Provider Information

NPI Number : 1366918583
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA MOLINA LCPC
Provider Business Mailing Address
First Line : 4150 W 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4242
Country : US
Telephone Number : 312-747-1563
Fax Number :
Provider Business Practice Location Address
First Line : 4150 W 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4242
Country : US
Telephone Number : 312-747-1563
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2018
Last Update Date : 10/15/2018

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Directions to “ MARIA MOLINA LCPC” Practice Location

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