MEDICARE: MS. TIANA S GHAZZALI

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	103TS0200X	School Psychologist	1276565	IL
2	101YM0800X	Mental Health Counselor	178020623	IL

General Provider Information

NPI Number	:	1831808096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIANA S GHAZZALI

Provider Business Mailing Address
First Line	:	7252 S BENNETT AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-6704
Country	:	US
Telephone Number	:	773-717-3036
Fax Number	:

Provider Business Practice Location Address
First Line	:	6700 S CLYDE AVE APT 1N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-1194
Country	:	US
Telephone Number	:	312-774-3613
Fax Number	:

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

Provider Enumeration Date	:	11/16/2022
Last Update Date	:	05/07/2025

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