MEDICARE: NOSHEEN H HYDARI MS MFT, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	208.000302	IL

General Provider Information

NPI Number	:	1053756114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOSHEEN H HYDARI MS MFT, LMFT

Provider Business Mailing Address
First Line	:	2322 W AUGUSTA BLVD APT 3B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4872
Country	:	US
Telephone Number	:	630-965-6674
Fax Number	:

Provider Business Practice Location Address
First Line	:	2322 W AUGUSTA BLVD APT 3B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4872
Country	:	US
Telephone Number	:	630-965-6674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	12/15/2021

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