MEDICARE: ILSE EISELE LCPC, LGPC

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	LGPC00519	DC
2	101YP2500X	Professional Counselor	LC10266	MD

General Provider Information

NPI Number	:	1871122432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILSE EISELE LCPC, LGPC

Provider Business Mailing Address
First Line	:	1528 UPSHUR STREET NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011
Country	:	US
Telephone Number	:	240-305-7526
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 UNIVERSITY BLVD E STE 245
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-4646
Country	:	US
Telephone Number	:	240-305-7526
Fax Number	:

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

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	04/06/2020

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