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NPI Code Detail

MEDICARE: GARY MICHELSEN LCPC

MEDICARE: GARY MICHELSEN 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
1101YP2500XProfessional Counselor180002991IL
2101YM0800XMental Health Counselor180002991IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10081646697OTHERILBCBS

General Provider Information

NPI Number : 1700999240
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY MICHELSEN LCPC
Provider Business Mailing Address
First Line : 3436 N KENNICOTT AVE
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004-7814
Country : US
Telephone Number : 847-952-7460
Fax Number : 847-222-1754
Provider Business Practice Location Address
First Line : 3436 N KENNICOTT AVE
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004-7814
Country : US
Telephone Number : 847-952-7460
Fax Number : 847-222-1754
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2006
Last Update Date : 11/06/2024

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