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General NPI Number Information
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NPI Number | 1467184465
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Entity Type | Organization
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Legal Business Name | STARLING WELLNESS GROUP PLLC
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 3247 N LEAVITT
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City | CHICAGO
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State | IL
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Zip | 60618
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Country | US
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Telephone | 312-870-0245
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 W MONTROSE AVE # 777
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City | CHICAGO
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State | IL
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Zip | 60641-2140
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Country | US
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Telephone | 312-241-3495
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | FELICIA TYUS
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Credential | LCPC
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Telephone | 312-241-3495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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