MEDICARE: JEREMY YECHIEL BRESLER LPC

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	178.016841	IL

General Provider Information

NPI Number	:	1881374965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY YECHIEL BRESLER LPC

Provider Business Mailing Address
First Line	:	2852 W TOUHY AVE UNIT F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4458
Country	:	US
Telephone Number	:	314-956-8933
Fax Number	:

Provider Business Practice Location Address
First Line	:	3557 W PETERSON AVE # DOOR126
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3218
Country	:	US
Telephone Number	:	314-956-8933
Fax Number	:

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

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/30/2023

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