MEDICARE: METANOIA METHODS PLLC

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	:	1568232668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METANOIA METHODS PLLC

Provider Business Mailing Address
First Line	:	4026 N MARMORA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1727
Country	:	US
Telephone Number	:	773-726-2385
Fax Number	:

Provider Business Practice Location Address
First Line	:	4026 N MARMORA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1727
Country	:	US
Telephone Number	:	773-726-2385
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	JOANNA KLIMEK
Credential	:	LCPC
Telephone Number	:	773-726-2385

Provider Enumeration Date	:	01/09/2024
Last Update Date	:	01/09/2024

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