MEDICARE: RAYO COUNSELING AND COMMUNITY CO-OP

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	1041C0700X	Clinical Social Worker
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1750086781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYO COUNSELING AND COMMUNITY CO-OP

Provider Business Mailing Address
First Line	:	2714 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3920
Country	:	US
Telephone Number	:	708-328-8593
Fax Number	:

Provider Business Practice Location Address
First Line	:	2714 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3920
Country	:	US
Telephone Number	:	708-328-8593
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LAUREN HERSCH
Credential	:	LCSW
Telephone Number	:	415-328-9443

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	02/10/2026

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