MEDICARE: SUPPORTIVE SOLUTIONS COUNSELING CENTER, 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	1041C0700X	Clinical Social Worker	149.011487	IL

General Provider Information

NPI Number	:	1437438462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORTIVE SOLUTIONS COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	34121 N US HIGHWAY 45
Second Line	:	SUITE #227
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-1768
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	34121 N US HIGHWAY 45
Second Line	:	SUITE #227
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-1768
Country	:	US
Telephone Number	:	847-287-7203
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST/ PARTNER
Name	:	MRS. MARIBETH STRUEBING
Credential	:	MSW, LCSW
Telephone Number	:	847-287-7203

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	08/09/2011

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