MEDICARE: INSIGHT COUNSELING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist
3	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1902957962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSIGHT COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	3446 CLINTON AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-3322
Country	:	US
Telephone Number	:	773-852-1780
Fax Number	:

Provider Business Practice Location Address
First Line	:	3139 N LINCOLN AVE
Second Line	:	SUITE 207
City	:	CHICAGO
State	:	IL
Zip	:	60657-3114
Country	:	US
Telephone Number	:	773-852-1780
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DR. JOHN L. CARNEY
Credential	:	PSY.D., L.C.P.C
Telephone Number	:	773-852-1780

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	01/03/2008

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