MEDICARE: MS. SAMANTHA ANN MICHELLI LCPC, CCTP, CADC,NCC

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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	101YM0800X	Mental Health Counselor	180015925	IL

General Provider Information

NPI Number	:	1669080321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SAMANTHA ANN MICHELLI LCPC, CCTP, CADC,NCC

Provider Business Mailing Address
First Line	:	3111 N 76TH CT
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707-1106
Country	:	US
Telephone Number	:	708-689-7115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 E ERIE ST STE 525
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2980
Country	:	US
Telephone Number	:	248-250-2303
Fax Number	:

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

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	05/15/2025

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