=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598148256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHAYNA GOLDSTEIN, LMFT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2015
-----------------------------------------------------
Last Update Date | 06/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1770 W BERTEAU AVE #302A
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60613-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-590-2670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1770 W BERTEAU AVE #302A
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60613-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-590-2670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MARRIAGER AND FAMILY THERAPIST
-----------------------------------------------------
Name | MS. SHAYNA GOLDSTEIN
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 773-590-2670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------