MEDICARE: FAITHFULLY ALIGNING YOU COUNSELING AND WELLNESS, PLLC

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
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1851257091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITHFULLY ALIGNING YOU COUNSELING AND WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	159 NORTH SANGAMON STREET
Second Line	:	SUITE 200-#3425
City	:	CHICAGO
State	:	IL
Zip	:	60607
Country	:	US
Telephone Number	:	312-919-1842
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 NORTH SANGAMON STREET
Second Line	:	SUITE 200-#3425
City	:	CHICAGO
State	:	IL
Zip	:	60607
Country	:	US
Telephone Number	:	312-919-1842
Fax Number	:

Authorized Official
Title or Position	:	OWNER, LICENSED COUNSELOR
Name	:	DR. JENNIFER FAY SMITH
Credential	:	PHD, LCPC
Telephone Number	:	312-919-1842

Provider Enumeration Date	:	12/31/2025
Last Update Date	:	12/31/2025

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