MEDICARE: NADIA PARFENOVA LPC

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	178.016116	IL

General Provider Information

NPI Number	:	1518551274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADIA PARFENOVA LPC

Provider Business Mailing Address
First Line	:	1436 W IRVING PARK RD APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-7245
Country	:	US
Telephone Number	:	650-796-2520
Fax Number	:

Provider Business Practice Location Address
First Line	:	4809 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4495
Country	:	US
Telephone Number	:	312-574-0750
Fax Number	:

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

Provider Enumeration Date	:	02/23/2021
Last Update Date	:	02/23/2021

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