MEDICARE: EAST AURORA COUNSELING LTD

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1205352192	OTHER	IL	CAQH

General Provider Information

NPI Number	:	1598277147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST AURORA COUNSELING LTD

Provider Business Mailing Address
First Line	:	2755 CHURCH RD
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60502-9745
Country	:	US
Telephone Number	:	630-486-3800
Fax Number	:	630-486-3800

Provider Business Practice Location Address
First Line	:	2755 CHURCH RD
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60502-9745
Country	:	US
Telephone Number	:	630-486-3800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AMANDA ALLER GOLDMAN
Credential	:	LCPC
Telephone Number	:	630-486-3800

Provider Enumeration Date	:	11/03/2017
Last Update Date	:	12/27/2024

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