Tara Ashley Ouillette, LPC, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

178011859 Issued in IL

Practice address

180 N Michigan Ave Ste 1830
Chicago, IL 60601-7407

Phone

(773) 750-3505

NPI assigned

Feb 22, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1487721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1023557089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 N MICHIGAN AVE STE 1830",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606017407",
            "telephone_number": "773-750-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 N MICHIGAN AVE STE 1830",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606017407",
            "telephone_number": "773-750-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OUILLETTE",
        "first_name": "TARA",
        "middle_name": "ASHLEY",
        "credential": "LPC, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-22",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "HI",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178011859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023557089",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://intraspectrum-chicago.com/",
            "affiliation": "N",
            "endpointDescription": "Practice Website",
            "address_1": "180 N Michigan Ave Ste 1830",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606017407",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://intraspectrum-chicago.com/",
            "affiliation": "N",
            "endpointDescription": "Practice Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "180 N Michigan Ave Ste 1830",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606017407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; 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.