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General NPI Number Information
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NPI Number | 1588477319
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Entity Type | Organization
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Legal Business Name | RUSTUM THERAPY, LLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 4941 N KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60625-5009
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Country | US
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Telephone | 773-691-0086
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Fax |
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Provider Business Mailing Address
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Address Line | 4050 N MOZART ST
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City | CHICAGO
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State | IL
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Zip | 60618-2707
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Country | US
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Telephone | 773-691-0086
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HAMID RUSTUM
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Credential |
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Telephone | 773-691-0086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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