MEDICARE: FREDERICK CARY SHEPARD LPC

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	178012866	IL

General Provider Information

NPI Number	:	1598316291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK CARY SHEPARD LPC

Provider Business Mailing Address
First Line	:	4950 N MARINE DR APT 908
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3992
Country	:	US
Telephone Number	:	813-943-5255
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 N LINCOLN AVE STE 206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2422
Country	:	US
Telephone Number	:	773-469-6675
Fax Number	:

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

Provider Enumeration Date	:	09/24/2019
Last Update Date	:	09/24/2019

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