MEDICARE: DR. STACEE LEIGH-ANNE REICHERZER LLPC

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	20122	TX
2	101YP2500X	Professional Counselor	20122	TX
3	101Y00000X	Counselor	20122	TX

General Provider Information

NPI Number	:	1780379784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEE LEIGH-ANNE REICHERZER LLPC

Provider Business Mailing Address
First Line	:	828 W GRACE ST APT 1508
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5771
Country	:	US
Telephone Number	:	312-841-2205
Fax Number	:

Provider Business Practice Location Address
First Line	:	828 W GRACE ST APT 1508
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5771
Country	:	US
Telephone Number	:	312-841-2205
Fax Number	:

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

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	04/06/2023

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