MEDICARE: SEIZE THE WAY COUNSELING LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1538727730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEIZE THE WAY COUNSELING LLC

Provider Business Mailing Address
First Line	:	4800 N MILWAUKEE AVE STE 203
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2156
Country	:	US
Telephone Number	:	312-379-9035
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 N MILWAUKEE AVE STE 203
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2156
Country	:	US
Telephone Number	:	312-379-9035
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OLIVIA M MANSOUR
Credential	:	LCSW
Telephone Number	:	312-379-9035

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	06/03/2019

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