SAMANTHA DALLAS (NPI# 1710457478) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710457478 |
| Entity Type | Individual |
| Full Name | SAMANTHA DALLAS |
| Credential | LPC |
| Practice Address |
2402 N Lincoln Ave Chicago IL 60614-2415 |
| Mailing Address |
3805 Niblick Ct Crystal Lake IL 60012-2228 |
| Practice Telephone | 7734696675 |
| Mailing Telephone | 8154743380 |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2018-11-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
178.014261 | IL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CAQH | 14371810 | 01 |
| Street Address |
2402 N LINCOLN AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60614-2415 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972844306 | Michelle Sobon | Psychologist | 2402 N Lincoln Ave, Chicago, IL 60614-2415 | 2013-03-11 |
| 1487206793 | Timothy E. Dean | Psychologist | 2402 N Lincoln Ave, Chicago, IL 60614-2415 | 2019-07-16 |
| 1770041618 | Scott Robinowitz | Social Worker | 2402 N Lincoln Ave, Chicago, IL 60614-2415 | 2019-03-11 |
| 1902384878 | Chelsea Jo Derks | Social Worker | 2402 N Lincoln Ave, Chicago, IL 60614-2415 | 2018-08-02 |
| 1972011336 | Sean Mcmenamin | Social Worker | 2402 N Lincoln Ave, Chicago, IL 60614-2415 | 2018-01-18 |
| 1447771068 | Rebecca Hofrichter | Social Worker | 2402 N Lincoln Ave, Chicago, IL 60614-2415 | 2017-07-05 |
| 1568990968 | Brandon Kyle Bailys | Counselor | 2402 N Lincoln Ave, Chicago, IL 60614-2415 | 2017-05-30 |
| 1083168405 | Elizabeth Hutchinson | Counselor | 2402 N Lincoln Ave, Chicago, IL 60614-2415 | 2016-08-15 |
| 1265898720 | Mary Eskew | Social Worker | 2402 N Lincoln Ave, Chicago, IL 60614-2415 | 2016-01-13 |
| 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 | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609477579 | Shantrell Patrice Sutton | Counselor | 5042 W Erie St, Chicago, IL 60644-1604 | 2020-11-05 |
| 1073114591 | Alternative Schools Network | Counselor | 1807 W Sunnyside Ave, Chicago, IL 60640-5898 | 2020-11-02 |
| 1992306518 | Gravity and Grace Psychotherapy, Pllc | Counselor | 1305 S Michigan Ave Apt 602, Chicago, IL 60605-3398 | 2020-11-02 |
| 1811597263 | April Wilburne | Counselor | 804 E 54th St Apt 3, Chicago, IL 60615-4972 | 2020-10-27 |
| 1043810393 | Pamela Kranyak | Counselor | 30 N Michigan Ave Ste 925, Chicago, IL 60602-3463 | 2020-10-27 |
| 1003413378 | Erika Aguirre | Counselor | 5040 S Keating Ave., Chicago, IL 60632-4919 | 2020-10-08 |
| 1497361661 | Michael V Biederman | Counselor | 4254 N Mozart St Apt 2s, Chicago, IL 60618-1784 | 2020-09-22 |
| 1013523984 | Antionette Fisher | Counselor | 5703 S Peoria St, Chicago, IL 60621-2262 | 2020-09-16 |
| 1114532561 | Nefesh Counseling, LLC | Counselor | 3320 W Foster Ave # 124, Chicago, IL 60625-4813 | 2020-09-12 |
| 1114531043 | Katherine E Evans | Counselor | 1528 W Jonquil Ter Unit 2c, Chicago, IL 60626-5932 | 2020-09-08 |
| 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.