MEDICARE: ALEXA REA BRAININ 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	180.014336	IL

General Provider Information

NPI Number	:	1972245058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA REA BRAININ LCPC

Provider Business Mailing Address
First Line	:	2421 APPLE HILL LN
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-4654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2421 APPLE HILL LN
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-4654
Country	:	US
Telephone Number	:	312-331-0272
Fax Number	:

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

Provider Enumeration Date	:	04/10/2022
Last Update Date	:	04/10/2022

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