MEDICARE: BLAND & ASSOCIATES, INC

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	180003122	IL

General Provider Information

NPI Number	:	1831469824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLAND & ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	856 W BUENA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1646
Country	:	US
Telephone Number	:	773-404-8161
Fax Number	:	773-404-8162

Provider Business Practice Location Address
First Line	:	856 W BUENA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1646
Country	:	US
Telephone Number	:	773-404-8161
Fax Number	:	773-404-8162

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MICHAEL J BLAND
Credential	:	PSY,D., D.MIN., LCPC
Telephone Number	:	773-404-8161

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	02/01/2012

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