MEDICARE: MRS. MARGO ALENA MCCOLLISTER 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	101YP2500X	Professional Counselor	180008014	IL

General Provider Information

NPI Number	:	1528345287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARGO ALENA MCCOLLISTER LCPC

Provider Business Mailing Address
First Line	:	616 N LINCOLN AVE
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-1218
Country	:	US
Telephone Number	:	630-664-1449
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 N LINCOLN AVE
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-1218
Country	:	US
Telephone Number	:	630-664-1449
Fax Number	:

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

Provider Enumeration Date	:	11/09/2011
Last Update Date	:	04/18/2016

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