MEDICARE: ALEXANDRA TAVLAS 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	101Y00000X	Counselor	180015949	IL

General Provider Information

NPI Number	:	1679381446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA TAVLAS LCPC

Provider Business Mailing Address
First Line	:	2933 N KEDZIE AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7603
Country	:	US
Telephone Number	:	815-503-1065
Fax Number	:

Provider Business Practice Location Address
First Line	:	2933 N KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7603
Country	:	US
Telephone Number	:	708-292-8798
Fax Number	:

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

Provider Enumeration Date	:	12/24/2024
Last Update Date	:	12/24/2024

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