MEDICARE: MRS. TOLAYA GEREDINE 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	180012190	IL

General Provider Information

NPI Number	:	1982156550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TOLAYA GEREDINE LCPC

Provider Business Mailing Address
First Line	:	19710 GOVERNORS HWY STE 5
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-2081
Country	:	US
Telephone Number	:	312-898-5007
Fax Number	:

Provider Business Practice Location Address
First Line	:	19710 GOVERNORS HWY STE 5
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-2081
Country	:	US
Telephone Number	:	312-898-5007
Fax Number	:

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

Provider Enumeration Date	:	10/31/2016
Last Update Date	:	08/20/2025

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