MEDICARE: TALI FRIEDLAND PSYCHOTHERAPY PLLC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1528835717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALI FRIEDLAND PSYCHOTHERAPY PLLC

Provider Business Mailing Address
First Line	:	3511 N WILTON AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1941
Country	:	US
Telephone Number	:	574-329-4162
Fax Number	:

Provider Business Practice Location Address
First Line	:	3511 N WILTON AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1941
Country	:	US
Telephone Number	:	574-329-4162
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AVITAL FRIEDLAND
Credential	:	LCSW, PMH-C
Telephone Number	:	574-329-4162

Provider Enumeration Date	:	12/07/2023
Last Update Date	:	12/07/2023

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