MEDICARE: ANTONIO THOMAS 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	180.016285	IL

General Provider Information

NPI Number	:	1457169153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO THOMAS LCPC

Provider Business Mailing Address
First Line	:	2623 W FITCH AVE APT 2E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-3287
Country	:	US
Telephone Number	:	414-510-3002
Fax Number	:

Provider Business Practice Location Address
First Line	:	2623 W FITCH AVE APT 2E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-3287
Country	:	US
Telephone Number	:	414-510-3002
Fax Number	:

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

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	04/22/2026

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