Oak Park Behavioral Medicine LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071008285 Issued in IL

Legal business name

OAK PARK BEHAVIORAL MEDICINE LLC

Practice address

818 Harrison St
Suite 210
Oak Park, IL 60304-1144

Phone

(312) 725-6175

NPI assigned

Jul 14, 2012

Last updated

Jul 14, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tiffany Taft, PSYDNPI 1467714691

Title

Owner

Phone

(312) 725-6175

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tiffany H Taft, PSYD

  • Clinical Psychologist
  • Oak Park, IL
  • NPI 1467714691
  Medicare reassignment NPD Authorized official
• Emily Pondelicek, LCSW

  • Clinical Social Worker
  • Oak Park, IL
  • NPI 1114779865
  NPD
• Elizabeth Marie Conrad, PSY.D.

  • Clinical Psychologist
  • NPI 1740665132
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342224000000",
    "number": "1003161225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 S GROVE AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603041125",
            "telephone_number": "312-725-6175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 HARRISON ST",
            "address_2": "SUITE 210",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603041144",
            "telephone_number": "312-725-6175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK PARK BEHAVIORAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-14",
        "last_updated": "2012-07-14",
        "status": "A",
        "authorized_official_last_name": "TAFT",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-725-6175",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.