MEDICARE: DARA ALTSHULER LPC

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	178009340	IL

General Provider Information

NPI Number	:	1649695982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARA ALTSHULER LPC

Provider Business Mailing Address
First Line	:	2325 N ORCHARD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3303
Country	:	US
Telephone Number	:	312-914-0801
Fax Number	:

Provider Business Practice Location Address
First Line	:	935 W CHESTNUT ST
Second Line	:	SUITE 201, URBAN BALANCE
City	:	CHICAGO
State	:	IL
Zip	:	60642-5441
Country	:	US
Telephone Number	:	312-757-0043
Fax Number	:	312-226-9082

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

Provider Enumeration Date	:	02/24/2014
Last Update Date	:	03/17/2018

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Directions to “ DARA ALTSHULER LPC” Practice Location

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