MEDICARE: CITYSCAPE COUNSELING, P.C.

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	180010149	IL

General Provider Information

NPI Number	:	1780139337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITYSCAPE COUNSELING, P.C.

Provider Business Mailing Address
First Line	:	360 E SOUTH WATER ST
Second Line	:	APT 4404
City	:	CHICAGO
State	:	IL
Zip	:	60601-4028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 E SOUTH WATER ST
Second Line	:	APT 4404
City	:	CHICAGO
State	:	IL
Zip	:	60601-4028
Country	:	US
Telephone Number	:	224-420-0644
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHELSEA BATH
Credential	:
Telephone Number	:	224-420-0644

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	08/23/2016

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