MEDICARE: SERENITY COUNSELING CENTER

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	103TC0700X	Clinical Psychologist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01618891	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1851450761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY COUNSELING CENTER

Provider Business Mailing Address
First Line	:	2011 E 75TH SUITE 106
Second Line	:	PO BOX 19506
City	:	CHICAGO
State	:	IL
Zip	:	60649
Country	:	US
Telephone Number	:	773-643-0500
Fax Number	:	773-643-0545

Provider Business Practice Location Address
First Line	:	2011 E 75TH
Second Line	:	SUITE 103
City	:	CHICAGO
State	:	IL
Zip	:	60649
Country	:	US
Telephone Number	:	773-643-0500
Fax Number	:	773-643-0545

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HUGH LEE FLEMMING SR.
Credential	:	DMIN
Telephone Number	:	773-643-0500

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2020

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Directions to “SERENITY COUNSELING CENTER ” Practice Location

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