MEDICARE: SHIRA GALSTON LLC

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

General Provider Information

NPI Number	:	1073112595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIRA GALSTON LLC

Provider Business Mailing Address
First Line	:	2941 W LUNT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-2919
Country	:	US
Telephone Number	:	917-855-4994
Fax Number	:

Provider Business Practice Location Address
First Line	:	2941 W LUNT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-2919
Country	:	US
Telephone Number	:	917-855-4994
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	MRS. SHIRA GALSTON
Credential	:	LMFT
Telephone Number	:	917-855-4994

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	11/27/2023

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Directions to “SHIRA GALSTON LLC ” Practice Location

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