MEDICARE: ENRICHED LIVING COUNSELING LLC

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1902415854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENRICHED LIVING COUNSELING LLC

Provider Business Mailing Address
First Line	:	PO BOX 60472
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-0472
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1546 W SHERWIN AVE APT 1S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-2138
Country	:	US
Telephone Number	:	513-262-1680
Fax Number	:

Authorized Official
Title or Position	:	MARRIAGE AND FAMILY THERAPIST
Name	:	FARRAH WALKER
Credential	:	LMFT
Telephone Number	:	847-780-6023

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	07/27/2020

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