MEDICARE: MR. BENJAMIN JAMES THOMPSON LPC

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	178.007733	IL

General Provider Information

NPI Number	:	1689941122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN JAMES THOMPSON LPC

Provider Business Mailing Address
First Line	:	2620 N SAWYER AVE # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1612
Country	:	US
Telephone Number	:	612-481-7923
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 N SAWYER AVE # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1612
Country	:	US
Telephone Number	:	612-481-7923
Fax Number	:

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

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	11/29/2011

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