MEDICARE: IRINA BUSTIN

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1174075667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA BUSTIN

Provider Business Mailing Address
First Line	:	1200 W 35TH ST STE 5B5220
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1305
Country	:	US
Telephone Number	:	312-800-1767
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 W 35TH ST STE 5B5220
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1305
Country	:	US
Telephone Number	:	312-800-1767
Fax Number	:

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

Provider Enumeration Date	:	10/31/2016
Last Update Date	:	12/07/2020

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Directions to “ IRINA BUSTIN ” Practice Location

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