Provider Demographics
NPI:1396533469
Name:NORTHSTAR COUNSELING & CONSULTING LLC
Entity type:Organization
Organization Name:NORTHSTAR COUNSELING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GLYNN
Authorized Official - Middle Name:E,
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:256-434-7505
Mailing Address - Street 1:PO BOX 1084
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:TN
Mailing Address - Zip Code:38449-1084
Mailing Address - Country:US
Mailing Address - Phone:256-434-7505
Mailing Address - Fax:
Practice Address - Street 1:1231 CAMPGORUND RD.
Practice Address - Street 2:
Practice Address - City:NORTHPORT,
Practice Address - State:AL
Practice Address - Zip Code:35475
Practice Address - Country:US
Practice Address - Phone:256-434-7505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)