MEDICARE: 6 2 COUNSELING 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	:	1386415461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	6 2 COUNSELING LLC

Provider Business Mailing Address
First Line	:	518 W RIDGEMONT RD
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-7226
Country	:	US
Telephone Number	:	309-306-2524
Fax Number	:

Provider Business Practice Location Address
First Line	:	3106 N SHERWOOD AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-1339
Country	:	US
Telephone Number	:	309-306-2524
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LICENSED COUNSELOR
Name	:	KYLE FREIBURGER
Credential	:	LCPC
Telephone Number	:	309-306-2524

Provider Enumeration Date	:	01/09/2024
Last Update Date	:	01/09/2024

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