MEDICARE: COPING PLACE COUNSELING SERVICES, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1649860057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPING PLACE COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	7300 W COLLEGE DR STE 101
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1181
Country	:	US
Telephone Number	:	708-586-7100
Fax Number	:	708-586-7112

Provider Business Practice Location Address
First Line	:	7300 W COLLEGE DR STE 101
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1181
Country	:	US
Telephone Number	:	708-586-7100
Fax Number	:	708-586-7112

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	EDYTA ZURAWSKI
Credential	:	MA, LCPC
Telephone Number	:	708-522-9618

Provider Enumeration Date	:	01/20/2021
Last Update Date	:	02/07/2022

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