MEDICARE: MRS. T'CIA CHATMAN LSW

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1568186724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. T'CIA CHATMAN LSW

Provider Business Mailing Address
First Line	:	1127 W IOWA ST
Second Line	:
City	:	GLENWOOD
State	:	IL
Zip	:	60425-1024
Country	:	US
Telephone Number	:	708-674-1723
Fax Number	:

Provider Business Practice Location Address
First Line	:	5214 N WESTERN AVE STE 104
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2588
Country	:	US
Telephone Number	:	773-756-1733
Fax Number	:

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

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	09/30/2022

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