NPIMap

Organization Active NPI

Obsidian Counseling and Wellness, LLC

  • Mental Health Counselor
  • Northbrook, IL
National Provider Identifier
1003396599
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
OBSIDIAN COUNSELING AND WELLNESS, LLC
Practice address
1200 Shermer Rd Ste 203
Northbrook, IL 60062-4500
Phone
(847) 208-2972
NPI assigned
Aug 15, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Authorized official

Name
Ilyssa LaskyNPI 1639671001
Title
Owner
Phone
(847) 208-2972

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

1200 Shermer Rd Ste 203
Northbrook, IL 60062-4500

Mailing address

723 Elm St Ste 20
Winnetka, IL 60093-2565

National Provider Directory

National Provider Directory

Locations

1200 Shermer Rd
Ste 203
Northbrook, IL 60062
Phone (765) 532-6495

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1534291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1003396599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "723 ELM ST STE 20",
            "city": "WINNETKA",
            "state": "IL",
            "postal_code": "600932565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SHERMER RD STE 203",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600624500",
            "telephone_number": "847-208-2972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBSIDIAN COUNSELING AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-15",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "LASKY",
        "authorized_official_first_name": "ILYSSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-208-2972"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.