MEDICARE: MS. CATHERINE MARIE CHRISTOFILAKOS 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		IL

General Provider Information

NPI Number	:	1699883611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHERINE MARIE CHRISTOFILAKOS LCPC

Provider Business Mailing Address
First Line	:	2700 W LAWRENCE AVE
Second Line	:	SUITE Y
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-1181
Country	:	US
Telephone Number	:	217-787-1616
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 W LAWRENCE AVE
Second Line	:	SUITE Y
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-1181
Country	:	US
Telephone Number	:	217-787-1616
Fax Number	:

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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