MEDICARE: CASTING A LIGHT PSYCHOTHERAPY, P.C.

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	:	1306607437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTING A LIGHT PSYCHOTHERAPY, P.C.

Provider Business Mailing Address
First Line	:	3320 W FOSTER AVE # 127
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-4813
Country	:	US
Telephone Number	:	312-298-9637
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 W FOSTER AVE # 127
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-4813
Country	:	US
Telephone Number	:	312-298-9637
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	JORDAN PERLMAN
Credential	:	LCPC
Telephone Number	:	312-298-9637

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	07/30/2024

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