MEDICARE: BRIAN PELLETIER 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	101YM0800X	Mental Health Counselor	180.017306	IL

General Provider Information

NPI Number	:	1407538663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN PELLETIER LCPC

Provider Business Mailing Address
First Line	:	1217 W LUNT AVE APT 1A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-3048
Country	:	US
Telephone Number	:	224-420-7027
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 N CICERO AVE STE 606
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5721
Country	:	US
Telephone Number	:	224-420-7027
Fax Number	:

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/08/2025

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