Provider Demographics
NPI:1174089031
Name:STAR CONSULTING SERVICES
Entity type:Organization
Organization Name:STAR CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAVONDA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-680-0710
Mailing Address - Street 1:6316 GARDEN VIEW LN # 1
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2489
Mailing Address - Country:US
Mailing Address - Phone:773-680-0710
Mailing Address - Fax:
Practice Address - Street 1:900 W 63RD PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-2000
Practice Address - Country:US
Practice Address - Phone:773-680-0710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL355448094001Medicaid
1477561116OtherNPI