Healthcare Provider Details

I. General information

NPI: 1174089031
Provider Name (Legal Business Name): STAR CONSULTING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 63RD PKWY
CHICAGO IL
60621-2000
US

IV. Provider business mailing address

6316 GARDEN VIEW LN # 1
MATTESON IL
60443-2489
US

V. Phone/Fax

Practice location:
  • Phone: 773-680-0710
  • Fax:
Mailing address:
  • Phone: 773-680-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. SHAVONDA LATRICE FIELDS
Title or Position: EXECUTIVE DIRECTOR/PRESIDENT
Credential:
Phone: 773-680-0710