MEDICARE: PADILLA COUNSELING, LTD.

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	180008321	IL

General Provider Information

NPI Number	:	1871043364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PADILLA COUNSELING, LTD.

Provider Business Mailing Address
First Line	:	125 WINDSOR DR
Second Line	:	113
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1536
Country	:	US
Telephone Number	:	708-435-9224
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 WINDSOR DR
Second Line	:	113
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1536
Country	:	US
Telephone Number	:	708-435-9224
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	KRISTY V PADILLA
Credential	:	LCPC
Telephone Number	:	708-435-9224

Provider Enumeration Date	:	10/07/2016
Last Update Date	:	10/07/2016

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