MEDICARE: KOREY MCWILLIAMS, LLC

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	:	1366951071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOREY MCWILLIAMS, LLC

Provider Business Mailing Address
First Line	:	1146 W MORSE AVE APT 4A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-3587
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 W IRVING PARK RD STE 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4932
Country	:	US
Telephone Number	:	312-543-0438
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KOREY MCWILLIAMS
Credential	:
Telephone Number	:	312-543-0438

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	09/26/2017

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