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General NPI Number Information
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NPI Number | 1174089031
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Entity Type | Organization
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Legal Business Name | STAR CONSULTING SERVICES
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Dates
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Enumeration Date | 02/15/2019
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Last Update Date | 02/15/2019
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Provider Practice Location Address
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Address Line | 900 W 63RD PKWY
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City | CHICAGO
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State | IL
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Zip | 60621-2000
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Country | US
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Telephone | 773-680-0710
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Fax |
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Provider Business Mailing Address
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Address Line | 6316 GARDEN VIEW LN # 1
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City | MATTESON
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State | IL
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Zip | 60443-2489
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Country | US
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Telephone | 773-680-0710
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/PRESIDENT
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Name | MS. SHAVONDA LATRICE FIELDS
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Credential |
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Telephone | 773-680-0710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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