Provider Demographics
NPI:1720762123
Name:CUTTING EDGE COUNSELING OF THE NORTH SHORE, NFP
Entity Type:Organization
Organization Name:CUTTING EDGE COUNSELING OF THE NORTH SHORE, NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BREMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-525-7074
Mailing Address - Street 1:47 PARK VIEW LN
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8968
Mailing Address - Country:US
Mailing Address - Phone:847-525-7074
Mailing Address - Fax:
Practice Address - Street 1:3000 DUNDEE RD STE 418
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2436
Practice Address - Country:US
Practice Address - Phone:847-525-7074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty