MEDICARE: GREGORY SCOTT VINIARD 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	:	1720280480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY SCOTT VINIARD LCPC

Provider Business Mailing Address
First Line	:	3001 SPRING MILL DR
Second Line	:	SUITE D
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-6566
Country	:	US
Telephone Number	:	217-546-3100
Fax Number	:	217-546-3284

Provider Business Practice Location Address
First Line	:	3001 SPRING MILL DR
Second Line	:	SUITE D
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-6566
Country	:	US
Telephone Number	:	217-546-3100
Fax Number	:	217-546-3284

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/08/2007

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