MEDICARE: COUNSELING CENTER OF LAKE VIEW

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710042437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING CENTER OF LAKE VIEW

Provider Business Mailing Address
First Line	:	3225 N SHEFFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-2210
Country	:	US
Telephone Number	:	773-549-5886
Fax Number	:	773-549-3265

Provider Business Practice Location Address
First Line	:	3225 N SHEFFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-2210
Country	:	US
Telephone Number	:	773-549-5886
Fax Number	:	773-549-3265

Authorized Official
Title or Position	:	CONTROLLER
Name	:	DANIEL KANTER
Credential	:
Telephone Number	:	773-549-5886

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	06/29/2011

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Directions to “COUNSELING CENTER OF LAKE VIEW ” Practice Location

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