MEDICARE: ECHO THERAPY GROUP, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1841049582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECHO THERAPY GROUP, LLC

Provider Business Mailing Address
First Line	:	5419 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3686
Country	:	US
Telephone Number	:	773-510-4072
Fax Number	:

Provider Business Practice Location Address
First Line	:	5419 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3686
Country	:	US
Telephone Number	:	773-510-4072
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BARBARA MURPHY
Credential	:	LCSW
Telephone Number	:	773-510-4072

Provider Enumeration Date	:	05/15/2024
Last Update Date	:	05/15/2024

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