MEDICARE: MRS. COLLEEN CATHERINE VARGAS LCPC, CADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	33072	IL
2	101YP2500X	Professional Counselor	180.010789	IL

General Provider Information

NPI Number	:	1760961379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COLLEEN CATHERINE VARGAS LCPC, CADC

Provider Business Mailing Address
First Line	:	3942 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4639
Country	:	US
Telephone Number	:	773-564-9070
Fax Number	:

Provider Business Practice Location Address
First Line	:	3942 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4639
Country	:	US
Telephone Number	:	773-564-9070
Fax Number	:

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

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	08/14/2018

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