MEDICARE: NORTHSHORE RELATIONAL 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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1912744368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSHORE RELATIONAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	3 DURHAM CT
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-3416
Country	:	US
Telephone Number	:	224-392-8327
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 DURHAM CT
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-3416
Country	:	US
Telephone Number	:	224-392-8327
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HEATHER CHAMBERLAND
Credential	:	PSY.D.
Telephone Number	:	847-303-4000

Provider Enumeration Date	:	07/12/2024
Last Update Date	:	07/12/2024

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