MEDICARE: SILVIA Y AVILA MA, 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
2	261QM0850X	Adult Mental Health Clinic/Center
3	101YP2500X	Professional Counselor	180.008964	IL
4	101Y00000X	Counselor

General Provider Information

NPI Number	:	1538464193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SILVIA Y AVILA MA, LCPC

Provider Business Mailing Address
First Line	:	1200 W 35TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1305
Country	:	US
Telephone Number	:	773-850-7366
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 W 35TH ST
Second Line	:	SUITE 5E5560
City	:	CHICAGO
State	:	IL
Zip	:	60609-1305
Country	:	US
Telephone Number	:	773-850-7366
Fax Number	:

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

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	07/08/2023

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