MEDICARE: BECKY D. BUMHIRA L.C.P.C.

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	101YP2500X	Professional Counselor	180.004283	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1634456	OTHER	IL	BLUE CROSS BLUE SHIELD
2	734015000	OTHER	IL	MAGELLAN
3	7092683	OTHER	IL	AETNA

General Provider Information

NPI Number	:	1861513590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKY D. BUMHIRA L.C.P.C.

Provider Business Mailing Address
First Line	:	4547 N CLAREMONT AVE
Second Line	:	# 1
City	:	CHICAGO
State	:	IL
Zip	:	60625-7450
Country	:	US
Telephone Number	:	773-330-6299
Fax Number	:

Provider Business Practice Location Address
First Line	:	4305 N LINCOLN AVE
Second Line	:	SUITE U
City	:	CHICAGO
State	:	IL
Zip	:	60618-1711
Country	:	US
Telephone Number	:	773-330-6299
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	01/31/2011

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