MEDICARE: TRI-COUNTY COUNSELING SERVICES, P.C.

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	1041C0700X	Clinical Social Worker	149009158	IL

General Provider Information

NPI Number	:	1376693143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-COUNTY COUNSELING SERVICES, P.C.

Provider Business Mailing Address
First Line	:	346 TAFT AVE
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-6296
Country	:	US
Telephone Number	:	630-698-0390
Fax Number	:

Provider Business Practice Location Address
First Line	:	346 TAFT AVE
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-6296
Country	:	US
Telephone Number	:	630-698-0390
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MR. ROB JAMES BENDER
Credential	:	LCSW
Telephone Number	:	630-698-0390

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	08/30/2013

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