MEDICARE: AMY MCCAUSLAND 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	180016655	IL

General Provider Information

NPI Number	:	1548071038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MCCAUSLAND LCPC

Provider Business Mailing Address
First Line	:	6160 N CICERO AVE STE 630
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4325
Country	:	US
Telephone Number	:	773-932-9597
Fax Number	:	773-243-0519

Provider Business Practice Location Address
First Line	:	6160 N CICERO AVE STE 630
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4325
Country	:	US
Telephone Number	:	773-932-9597
Fax Number	:	773-243-0519

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

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	01/15/2025

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