MEDICARE: TESSA R BEUKEMA 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	101Y00000X	Counselor	180010864	IL
2	101YM0800X	Mental Health Counselor	180010864	IL
3	101YP2500X	Professional Counselor	180010864	IL

General Provider Information

NPI Number	:	1609214154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESSA R BEUKEMA LCPC

Provider Business Mailing Address
First Line	:	3051 N MILWAUKEE AVE UNIT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6612
Country	:	US
Telephone Number	:	773-827-4791
Fax Number	:

Provider Business Practice Location Address
First Line	:	4256 N RAVENSWOOD AVE STE 310
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1114
Country	:	US
Telephone Number	:	773-827-4791
Fax Number	:

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

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	07/21/2022

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