BLACK TIE THERAPY (NPI# 1073156196) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073156196 |
| Entity Type | Organization |
| Organization Name | BLACK TIE THERAPY |
| Practice Address |
2232 N Wayne Ave Apt 1f Chicago IL 60614-8937 |
| Practice Telephone | 7732178426 |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2020-09-04 |
| Authorized Official Name | MYRON NELSON (PRESIDENT) |
| Authorized Official Telephone | 2168321907 |
| Authorized Official Credential | LCPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Street Address |
2232 N WAYNE AVE APT 1F |
| City | CHICAGO |
| State | IL |
| Zip Code | 60614-8937 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487266516 | Taylor Connington | Pharmacist | 843 W Armitage Ave, Chicago, IL 60614 | 2020-08-19 |
| 1356975692 | Amarilis Diaz | Social Worker | Terry Hefter Associates, LLC, 1731 N. Marcey Suite 535, Chicago, IL 60614 | 2020-02-25 |
| 1457902975 | Michele Waggoner | Physical Therapist | 2515 N. Clark St, Chicago, IL 60614 | 2019-09-25 |
| 1669031936 | Justin Pomeroy | Acupuncturist | 1350 W. Schubert Ave., Chicago, IL 60614 | 2019-06-11 |
| 1801451547 | Amanda Harris | Counselor | 2451 N Lincoln Ave # 206, Chicago, IL 60614 | 2019-05-08 |
| 1780164574 | Danielle Trokey | Psychiatry & Neurology | 2515 N Clark St Ste 801, Chicago, IL 60614 | 2018-08-21 |
| 1841707353 | Madison Counseling Solutions LLC | Social Worker | 2502 N. Clark St., Chicago, IL 60614 | 2018-01-05 |
| 1386154011 | Allison Cooper Boyan | Occupational Therapist | 1640 N. Wells St., Unit 103, Chicago, IL 60614 | 2017-10-09 |
| 1245759653 | Eileen Davidson Siegel | Physician Assistant | 2073 N. Clybourn Ave., Chicago, IL 60614 | 2017-09-18 |
| 1447779814 | Elizabeth Hobart | Psychologist | 1800 W. Diversey Pkwy, Unit H, Chicago, IL 60614 | 2017-09-16 |
| Find all providers in zip 60614 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336753896 | Counseling Kennedy Shenberg | Community/Behavioral Health | 5752 N Campbell Ave Apt 1, Chicago, IL 60659-5080 | 2020-09-02 |
| 1700498573 | Bobby E. Wright Comprehensive Behavioral Health Center, Inc. | Community/Behavioral Health | 5816 W Division St Fl 1, Chicago, IL 60651-1003 | 2020-08-21 |
| 1164030557 | Acorn & Oak Counseling Pllc | Community/Behavioral Health | 1333 W Devon Ave Ste 319, Chicago, IL 60660-1329 | 2020-07-21 |
| 1144848300 | Marathon Mindset Counseling LLC | Community/Behavioral Health | 1650 W Adams St Apt 304, Chicago, IL 60612-3209 | 2020-07-13 |
| 1417586678 | Invisions Behavioral Health LLC | Community/Behavioral Health | 8211 S Woodlawn Ave, Chicago, IL 60619-4519 | 2020-04-08 |
| 1871124784 | Nurture Therapy, LLC | Community/Behavioral Health | 3711 N Ravenswood Ave Ste 146, Chicago, IL 60613-5944 | 2020-01-29 |
| 1962032086 | Bucktown Therapy | Community/Behavioral Health | 1820 W Webster Ave Ste 200, Chicago, IL 60614-2934 | 2020-01-16 |
| 1770121436 | Guided Expressions LLC | Community/Behavioral Health | 6640 S University Ave Apt 2, Chicago, IL 60637-4320 | 2019-12-12 |
| 1063058279 | Y Not Families | Community/Behavioral Health | 6427 S Ashland Ave, Chicago, IL 60636-2716 | 2019-11-22 |
| 1073155958 | Chicago Health Clinic Nfp | Community/Behavioral Health | 6423 N Rockwell St, Chicago, IL 60645-5319 | 2019-10-12 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.