MEDICARE: ALISHIA MERCHERSON MA, 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	101YP2500X	Professional Counselor	180.008998	IL

General Provider Information

NPI Number	:	1578089827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISHIA MERCHERSON MA, LCPC

Provider Business Mailing Address
First Line	:	730 E 163RD PL
Second Line	:
City	:	SOUTH HOLLAND
State	:	IL
Zip	:	60473-2305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10540 S WESTERN AVE STE 403
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-2529
Country	:	US
Telephone Number	:	773-669-4743
Fax Number	:	773-634-7994

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

Provider Enumeration Date	:	08/18/2017
Last Update Date	:	04/25/2019

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