Healthcare Provider Details

I. General information

NPI: 1700709524
Provider Name (Legal Business Name): MICHELLE LYNN GOLDSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LAKEVIEW PKWY STE 180
VERNON HILLS IL
60061-1850
US

IV. Provider business mailing address

400 LAKEVIEW PKWY STE 180
VERNON HILLS IL
60061-1850
US

V. Phone/Fax

Practice location:
  • Phone: 847-996-6666
  • Fax: 847-996-6665
Mailing address:
  • Phone: 847-996-6666
  • Fax: 847-996-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: