MEDICARE: KLUTCH & WELL LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1932724564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLUTCH & WELL LLC

Provider Business Mailing Address
First Line	:	1132 S WABASH AVE STE 206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2326
Country	:	US
Telephone Number	:	773-413-0848
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 S WABASH AVE STE 206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2326
Country	:	US
Telephone Number	:	773-413-0848
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST & OWNER
Name	:	ANDREA STILES
Credential	:	LCPC, NCC, PHD(C)
Telephone Number	:	773-413-0848

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	06/09/2020

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Directions to “KLUTCH & WELL LLC ” Practice Location

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