ALLYSSA ROSE BERTRAM (NPI# 1366058075) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366058075 |
| Entity Type | Individual |
| Full Name | ALLYSSA ROSE BERTRAM |
| Credential | LCPC CADC |
| Practice Address |
4055 W Peterson Ave Ste 202 Chicago IL 60646-6183 |
| Mailing Address |
702 Dempster St Apt E105 Mount Prospect IL 60056-6154 |
| Practice Telephone | 7737744444 |
| Mailing Telephone | 4404525245 |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2020-09-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | 180.012157 | IL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | LCPC | 180.012157 | 01 |
| Street Address |
4055 W PETERSON AVE STE 202 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60646-6183 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801312087 | Manal Ibrahim | Dentist | 6228 N Keystone Ave, Chicago, IL 60646 | 2017-08-18 |
| 1750820742 | Kaitlin O'brien | Student in an Organized Health Care Education/Training Program | 5801 N Pulaski, Chicago, IL 60646 | 2017-02-23 |
| 1659810646 | Sofia Trani | Student in an Organized Health Care Education/Training Program | 5801 N. Pulaski Rd, Chicago, IL 60646 | 2017-02-23 |
| 1487191151 | Ronald E. Rysztogi | Naprapath | 5704 N. Austin, Chicago, IL 60646 | 2017-01-19 |
| 1417403148 | Joyful Dental Care | Clinic/Center | 6314 N. Cicero Avenue, Chicago, IL 60646 | 2016-09-01 |
| 1164889754 | Physicians At Call | Family Medicine | 5901 N. Cicero Ave, Ste 207, Chicago, IL 60646 | 2016-01-27 |
| 1245610617 | Arlett Payne | Physician Assistant | 5906 N Milwaukee, Chicago, IL 60646 | 2015-06-01 |
| 1811375843 | North River Mental Health Center | Community/Behavioral Health | 5801 North Pulaski Road, Chicago, IL 60646 | 2015-05-11 |
| 1003157298 | Family Choice Home Health | Homemaker | 5933 N Milwaukee Avenue, Chicago, IL 60646 | 2013-03-13 |
| 1235479593 | Antonina Skapars Trinkuns | Psychiatry & Neurology | 6404 N. Tahoma Ave., Chicago, IL 60646 | 2013-02-25 |
| Find all providers in zip 60646 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952914707 | Tara Ufer | Counselor | 400 W Deming Pl Apt 9g, Chicago, IL 60614-1702 | 2020-08-30 |
| 1104439694 | Alisa Williams | Counselor | 409 E 62nd St, Chicago, IL 60637-6097 | 2020-08-25 |
| 1730791492 | Forward Intentions Therapy LLC | Counselor | 1309 N Ashland Ave, Chicago, IL 60622-8744 | 2020-08-23 |
| 1184232183 | Isaac William Samuelson | Counselor | 3058 W Cortland St Apt 2, Chicago, IL 60647-5075 | 2020-07-16 |
| 1346861242 | Hannah Conner | Counselor | 2756 N Pine Grove Ave Apt 705, Chicago, IL 60614-6167 | 2020-05-01 |
| 1881215804 | Pamela Ann Brazelton-sykes | Counselor | Pioneer Gardens Supportive Living, 3800 S King Dr, Chicago, IL 60653 | 2020-04-30 |
| 1619597259 | Charles Chevell Hurt | Counselor | 1606 W Wallen Ave Apt 1, Chicago, IL 60626-6592 | 2020-04-23 |
| 1851911580 | Jessica C Baran | Counselor | 5200 S Blackstone Ave Apt 401, Chicago, IL 60615-6011 | 2020-04-22 |
| 1659907350 | Lauren Graner | Counselor | 2845 N Sheridan Rd # 708, Chicago, IL 60657-7227 | 2020-03-14 |
| 1255966784 | Three Raven Counseling, LLC | Counselor | 5215 N Ravenswood Ave Ste 312, Chicago, IL 60640-1670 | 2020-03-05 |
| 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.