MEDICARE: MRS. MIHAELA CAMPION 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	101YM0800X	Mental Health Counselor		IL

General Provider Information

NPI Number	:	1912914664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIHAELA CAMPION LCPC

Provider Business Mailing Address
First Line	:	930 W CUYLER AVE
Second Line	:	1E
City	:	CHICAGO
State	:	IL
Zip	:	60613-2449
Country	:	US
Telephone Number	:	773-348-4842
Fax Number	:

Provider Business Practice Location Address
First Line	:	5054 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3118
Country	:	US
Telephone Number	:	773-506-8971
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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