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General NPI Number Information
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NPI Number | 1770093361
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Entity Type | Organization
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Legal Business Name | NORTH STAR COUNSELING GROUP, LLC
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Dates
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Enumeration Date | 10/09/2017
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 209 E PARK ST STE B
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City | MUNDELEIN
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State | IL
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Zip | 60060-1972
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Country | US
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Telephone | 224-360-0688
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Fax | 847-566-0182
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Provider Business Mailing Address
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Address Line | 209 E PARK ST STE B
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City | MUNDELEIN
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State | IL
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Zip | 60060-1972
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Country | US
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Telephone | 224-360-0688
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Fax | 847-566-0182
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Authorized Official
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Title or Position | CO OWNER
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Name | JORI RISKE
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Credential | LCSW
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Telephone | 224-260-0688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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