MEDICARE: MICHAEL WILEY JR. 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	LH61301380	WA
2	101YM0800X	Mental Health Counselor	180.013996	IL
3	101YM0800X	Mental Health Counselor	LPC015458	GA

General Provider Information

NPI Number	:	1508487976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WILEY JR. LCPC

Provider Business Mailing Address
First Line	:	7234 W NORTH AVE STE 208
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-4202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7234 W NORTH AVE STE 208
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-4202
Country	:	US
Telephone Number	:	773-301-1329
Fax Number	:

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

Provider Enumeration Date	:	04/27/2020
Last Update Date	:	04/14/2025

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