MEDICARE: MR. THEODORE EDWARD STRIPLING 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	101YM0800X	Mental Health Counselor	180.014296	IL

General Provider Information

NPI Number	:	1700531787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THEODORE EDWARD STRIPLING LCPC

Provider Business Mailing Address
First Line	:	1152 N KEDZIE AVE APT 302
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-4182
Country	:	US
Telephone Number	:	312-852-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1152 N KEDZIE AVE APT 302
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-4182
Country	:	US
Telephone Number	:	312-852-2111
Fax Number	:

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

Provider Enumeration Date	:	02/17/2022
Last Update Date	:	02/17/2022

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