MEDICARE: MS. AMY MARIE DIAZ LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	IL
2	101YP2500X	Professional Counselor	IL
3	101YM0800X	Mental Health Counselor	IL

General Provider Information

NPI Number	:	1831535277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY MARIE DIAZ LCPC

Provider Business Mailing Address
First Line	:	100 N ATKINSON RD STE 106
Second Line	:
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-7805
Country	:	US
Telephone Number	:	224-513-1089
Fax Number	:	847-556-6535

Provider Business Practice Location Address
First Line	:	100 N ATKINSON RD STE 106
Second Line	:
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-7805
Country	:	US
Telephone Number	:	224-513-1089
Fax Number	:	847-556-6535

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

Provider Enumeration Date	:	05/13/2013
Last Update Date	:	05/06/2026

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