MEDICARE: MS. MAUREEN PATRICE TAMILLOW 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	180-001057	IL
2	101YM0800X	Mental Health Counselor	180-001057	IL
3	101YS0200X	School Counselor	2186312	IL
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	25778	IL

General Provider Information

NPI Number	:	1659438430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN PATRICE TAMILLOW LCPC

Provider Business Mailing Address
First Line	:	1145 S SCOVILLE AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60304-2129
Country	:	US
Telephone Number	:	708-386-1742
Fax Number	:	708-386-4217

Provider Business Practice Location Address
First Line	:	111 W CHICAGO AVE
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-3356
Country	:	US
Telephone Number	:	630-655-9040
Fax Number	:

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	04/21/2015

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