MEDICARE: NORTHSTAR RESTORATIVE COUNSELING LLC

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	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699327445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR RESTORATIVE COUNSELING LLC

Provider Business Mailing Address
First Line	:	1452 W WINONA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2821
Country	:	US
Telephone Number	:	847-312-6376
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 W MONTROSE AVE STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1674
Country	:	US
Telephone Number	:	847-312-6376
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	KATHRYN LAMBIE
Credential	:	LCPC
Telephone Number	:	847-312-6376

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	07/11/2019

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