MEDICARE: MISS LAUREN LOUISE BREIT LCPC, CADC, NCC, CST

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	29185	IL
2	101YP2500X	Professional Counselor	180.012738	IL

General Provider Information

NPI Number	:	1841738424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LAUREN LOUISE BREIT LCPC, CADC, NCC, CST

Provider Business Mailing Address
First Line	:	5215 N RAVENSWOOD AVE STE 312
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1670
Country	:	US
Telephone Number	:	872-239-5253
Fax Number	:

Provider Business Practice Location Address
First Line	:	5215 N RAVENSWOOD AVE STE 312
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1670
Country	:	US
Telephone Number	:	872-239-5253
Fax Number	:

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

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	01/16/2025

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