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General NPI Number Information
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NPI Number | 1942714084
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Entity Type | Organization
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Legal Business Name | SHORELINE PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 1940 SHERMAN AVE STE A
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City | EVANSTON
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State | IL
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Zip | 60201
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Country | US
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Telephone | 330-620-1043
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Fax |
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Provider Business Mailing Address
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Address Line | 620 CUSTER AVE
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City | EVANSTON
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State | IL
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Zip | 60202-2605
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MARRIAGE AND FAMILY THERAPIST
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Name | RACHEL GOLDSMITH
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Credential | LMFT
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Telephone | 847-868-2199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.001025
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License Number State | IL
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