MEDICARE: MS. CAYAMA CARROLL MA., LCPC

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	180010017	IL

General Provider Information

NPI Number	:	1902076417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAYAMA CARROLL MA., LCPC

Provider Business Mailing Address
First Line	:	7100 S SOUTH SHORE DR
Second Line	:	#706
City	:	CHICAGO
State	:	IL
Zip	:	60649-2700
Country	:	US
Telephone Number	:	772-544-6295
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 E MADISON ST
Second Line	:	SUITE 1421
City	:	CHICAGO
State	:	IL
Zip	:	60603-3014
Country	:	US
Telephone Number	:	773-544-6295
Fax Number	:

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

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	12/17/2015

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