MEDICARE: MR. ROBERT EUGENE FICKES JR. 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	180005821	IL

General Provider Information

NPI Number	:	1639186885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT EUGENE FICKES JR. LCPC

Provider Business Mailing Address
First Line	:	1400 MOSSMAN AVE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-4718
Country	:	US
Telephone Number	:	217-725-5623
Fax Number	:	217-528-1989

Provider Business Practice Location Address
First Line	:	925 S SPRING ST
Second Line	:	SUITE B
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-2784
Country	:	US
Telephone Number	:	217-528-1988
Fax Number	:	217-528-1989

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	03/23/2010

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