MEDICARE: CORTNEY HOM 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	178.014729	IL
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor	180.013687	IL

General Provider Information

NPI Number	:	1679078612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORTNEY HOM LCPC

Provider Business Mailing Address
First Line	:	750 BROADWAY AVE E
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-4610
Country	:	US
Telephone Number	:	217-238-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 N SHEFFIELD AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5003
Country	:	US
Telephone Number	:	312-775-2294
Fax Number	:

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

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	03/30/2024

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Directions to “ CORTNEY HOM LCPC” Practice Location

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