MEDICARE: CHICAGO ANXIETY COUNSELING, SUPERVISION, AND CONSULTATION INC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1538934021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO ANXIETY COUNSELING, SUPERVISION, AND CONSULTATION INC

Provider Business Mailing Address
First Line	:	3950 N LAKE SHORE DR UNIT 205A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3434
Country	:	US
Telephone Number	:	313-655-0351
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 W IRVING PARK RD STE 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4932
Country	:	US
Telephone Number	:	872-529-1980
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SONILA SEJDARAS
Credential	:	PSYD
Telephone Number	:	313-655-0351

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	11/15/2023

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