MEDICARE: CHRISTINA MARIE DYER 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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	180-003408	IL

General Provider Information

NPI Number	:	1538912092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARIE DYER LCPC

Provider Business Mailing Address
First Line	:	2944 AVON RD
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-4937
Country	:	US
Telephone Number	:	815-476-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N ASHLAND AVE STE 500
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-8327
Country	:	US
Telephone Number	:	815-476-5600
Fax Number	:

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

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	02/16/2026

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