MEDICARE: JAMES ROBERT FATZ PHD, LMHC, 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	MH15360	FL

General Provider Information

NPI Number	:	1982884177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ROBERT FATZ PHD, LMHC, LCPC

Provider Business Mailing Address
First Line	:	1341 CORAL BERRY CT
Second Line	:
City	:	YORKVILLE
State	:	IL
Zip	:	60560-9125
Country	:	US
Telephone Number	:	815-751-1097
Fax Number	:

Provider Business Practice Location Address
First Line	:	1341 CORAL BERRY CT
Second Line	:
City	:	YORKVILLE
State	:	IL
Zip	:	60560-9125
Country	:	US
Telephone Number	:	815-751-1097
Fax Number	:

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

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	09/19/2020

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