Provider Demographics
NPI:1073112595
Name:SHIRA GALSTON LLC
Entity Type:Organization
Organization Name:SHIRA GALSTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:917-855-4994
Mailing Address - Street 1:2941 W LUNT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2919
Mailing Address - Country:US
Mailing Address - Phone:917-855-4994
Mailing Address - Fax:
Practice Address - Street 1:2941 W LUNT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2919
Practice Address - Country:US
Practice Address - Phone:917-855-4994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty