FANDOM BEHAVIORAL HEALTH CLINIC PLLC NPI 1942913280

NPI Information

NPI: 1942913280
Provider Name: FANDOM BEHAVIORAL HEALTH CLINIC PLLC
Classification: Counselor - 101YP2500X
Entity Type: Organization

Specialization: Professional

Address:
564 W RANDOLPH ST UNIT 820
CHICAGO, IL
ZIP 60661
Phone: (708) 789-5669
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FANDOM BEHAVIORAL HEALTH CLINIC PLLC is a professional counselor in Chicago, IL. FANDOM BEHAVIORAL HEALTH CLINIC PLLC NPI is 1942913280. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

564 W RANDOLPH ST UNIT 820
CHICAGO, IL
ZIP 60661-218
Phone: (708) 789-5669

The provider's authorized official is Larry Lee Woods .
The authorized official title is Professional Counselor and has the following contact phone number (803) 719-3237.

The enumeration date for this NPI number is 1/2/2023 and was last updated on 3/3/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YP2500X	Counselor	Professional			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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