MEDICARE: TRACY K DURKAN LCPC

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	178.009667	IL
2	101YP2500X	Professional Counselor	180.010081	IL

General Provider Information

NPI Number	:	1811315526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY K DURKAN LCPC

Provider Business Mailing Address
First Line	:	2327 N SACRAMENTO AVE
Second Line	:	UNIT 1
City	:	CHICAGO
State	:	IL
Zip	:	60647
Country	:	US
Telephone Number	:	607-351-3977
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 LAKE COOK RD STE 303
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1452
Country	:	US
Telephone Number	:	312-239-6016
Fax Number	:

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

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	03/17/2018

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