MEDICARE: MS. TAWANNA L DANIELS 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	180.009930	IL

General Provider Information

NPI Number	:	1407318728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAWANNA L DANIELS LCPC

Provider Business Mailing Address
First Line	:	1027 WASHINGTON BLVD APT 101
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-3753
Country	:	US
Telephone Number	:	708-218-8260
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 HARRISON ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60304-1533
Country	:	US
Telephone Number	:	708-218-8260
Fax Number	:

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

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	10/18/2023

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