MEDICARE: EATING RECOVERY CENTER INSIGHT

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	180.009963	IL

General Provider Information

NPI Number	:	1669915831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EATING RECOVERY CENTER INSIGHT

Provider Business Mailing Address
First Line	:	1535 LAKE COOK RD STE 303
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1452
Country	:	US
Telephone Number	:	847-378-7246
Fax Number	:	847-559-9428

Provider Business Practice Location Address
First Line	:	1535 LAKE COOK RD STE 303
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1452
Country	:	US
Telephone Number	:	847-378-7246
Fax Number	:	847-559-9428

Authorized Official
Title or Position	:	CLINICAL MANAGER
Name	:	JENNIFER L MCADAMS
Credential	:	LCPC
Telephone Number	:	847-997-3910

Provider Enumeration Date	:	11/21/2016
Last Update Date	:	11/21/2016

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