MEDICARE: AMMIRATI COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	101Y00000X	Counselor	IL
2	102L00000X	Psychoanalyst	IL
3	101YM0800X	Mental Health Counselor	IL

General Provider Information

NPI Number	:	1568956696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMMIRATI COUNSELING

Provider Business Mailing Address
First Line	:	9344 LAWNDALE AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60203-1305
Country	:	US
Telephone Number	:	847-217-9381
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 LAKESIDE DR
Second Line	:
City	:	BANNOCKBURN
State	:	IL
Zip	:	60015-1265
Country	:	US
Telephone Number	:	847-217-9381
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TERESA AMMIRATI
Credential	:	LCPC
Telephone Number	:	847-217-9381

Provider Enumeration Date	:	06/21/2018
Last Update Date	:	07/21/2022

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