MEDICARE: HEARTEN THERAPY, PLLC

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1346949757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTEN THERAPY, PLLC

Provider Business Mailing Address
First Line	:	915 N RACINE AVE APT 2SE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-0008
Country	:	US
Telephone Number	:	262-408-0645
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 N RACINE AVE APT 2SE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-0008
Country	:	US
Telephone Number	:	262-408-0645
Fax Number	:

Authorized Official
Title or Position	:	LMFT
Name	:	EMILY NIKOLAUS BUETTNER
Credential	:	LMFT
Telephone Number	:	262-408-0645

Provider Enumeration Date	:	02/24/2023
Last Update Date	:	03/08/2023

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