MEDICARE: RICHARD HELLER LCPC, MDIV

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	101Y00000X	Counselor	180.005419	IL
2	101YM0800X	Mental Health Counselor	180.005419	IL
3	101YP1600X	Pastoral Counselor	180.005419	IL
4	101YP2500X	Professional Counselor	180.005419	IL

General Provider Information

NPI Number	:	1598130841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD HELLER LCPC, MDIV

Provider Business Mailing Address
First Line	:	1832 W CRESCENT AVE
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-3878
Country	:	US
Telephone Number	:	847-823-4767
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 N WOOD DALE RD
Second Line	:
City	:	WOOD DALE
State	:	IL
Zip	:	60191-2029
Country	:	US
Telephone Number	:	847-571-7015
Fax Number	:

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

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	12/10/2015

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