MEDICARE: CHOICES TREATMENT SERVICES, LTD

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	149-007201	IL

General Provider Information

NPI Number	:	1760799225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICES TREATMENT SERVICES, LTD

Provider Business Mailing Address
First Line	:	429 W OHIO ST
Second Line	:	SUITE #2301
City	:	CHICAGO
State	:	IL
Zip	:	60654-4506
Country	:	US
Telephone Number	:	773-224-9887
Fax Number	:	773-224-9887

Provider Business Practice Location Address
First Line	:	400 W 76TH ST
Second Line	:	SUITE #226
City	:	CHICAGO
State	:	IL
Zip	:	60620-1640
Country	:	US
Telephone Number	:	773-224-9887
Fax Number	:	773-224-9887

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. HARRY MACK THOMAS
Credential	:	LCSW
Telephone Number	:	312-339-0726

Provider Enumeration Date	:	09/06/2010
Last Update Date	:	09/06/2010

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