MEDICARE: MR. CARL G WINTON JR.

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		IL

General Provider Information

NPI Number	:	1760159164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARL G WINTON JR.

Provider Business Mailing Address
First Line	:	56 E 47TH ST STE 400C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3846
Country	:	US
Telephone Number	:	312-724-2139
Fax Number	:

Provider Business Practice Location Address
First Line	:	1136 S DELANO CT W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-3740
Country	:	US
Telephone Number	:	312-577-7285
Fax Number	:

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

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	04/15/2022

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