MEDICARE: BUILD QUALITY LIFE

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	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1891502555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILD QUALITY LIFE

Provider Business Mailing Address
First Line	:	360 E SOUTH WATER ST # 1681
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-4028
Country	:	US
Telephone Number	:	312-447-9906
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 E SOUTH WATER ST # 1681
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-4028
Country	:	US
Telephone Number	:	312-447-9906
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARSON D JAMES
Credential	:	LPCP
Telephone Number	:	312-447-9906

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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Directions to “BUILD QUALITY LIFE ” Practice Location

Language	Start Address	Practice Location

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