MEDICARE: NORTHSTAR THERAPY IN NORTHBROOK

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	:	1619699287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR THERAPY IN NORTHBROOK

Provider Business Mailing Address
First Line	:	1021 N WOOD ST APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4349
Country	:	US
Telephone Number	:	815-276-1224
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 N WOOD ST APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4349
Country	:	US
Telephone Number	:	815-276-1224
Fax Number	:

Authorized Official
Title or Position	:	OWNER & OPERATOR
Name	:	MRS. CAITLYN DAWN DOLINS
Credential	:	LMFT
Telephone Number	:	815-276-1224

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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Directions to “NORTHSTAR THERAPY IN NORTHBROOK ” Practice Location

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