MEDICARE: NEW CONSTELLATIONS THERAPY

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	:	1255980223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW CONSTELLATIONS THERAPY

Provider Business Mailing Address
First Line	:	2109 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3923
Country	:	US
Telephone Number	:	773-692-4558
Fax Number	:	773-825-8188

Provider Business Practice Location Address
First Line	:	2109 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3923
Country	:	US
Telephone Number	:	773-692-4558
Fax Number	:	773-825-8188

Authorized Official
Title or Position	:	FOUNDER & PSYCHOTHERAPIST
Name	:	KELLY L GEORGE
Credential	:	LCPC
Telephone Number	:	773-692-4558

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	02/10/2026

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Directions to “NEW CONSTELLATIONS THERAPY ” Practice Location

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