MEDICARE: CREATE COUNSELING CENTER 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	101YP2500X	Professional Counselor	180.007744	IL

General Provider Information

NPI Number	:	1861766107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATE COUNSELING CENTER PLLC

Provider Business Mailing Address
First Line	:	1757 N KIMBALL AVE STE 206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4805
Country	:	US
Telephone Number	:	773-969-6811
Fax Number	:

Provider Business Practice Location Address
First Line	:	1757 N KIMBALL AVE STE 206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4805
Country	:	US
Telephone Number	:	773-969-6811
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MS. CHERIE L LUSKY
Credential	:	LCPC
Telephone Number	:	773-969-6811

Provider Enumeration Date	:	03/05/2012
Last Update Date	:	08/01/2023

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