Amy Fayazrad, PSY.D.

Individual provider Active NPI Mental Health Counselor · Arlington Heights, IL

NPI 1043440910 · NPPES record last updated Sep 30, 2015

Key facts

NPI
1043440910
Entity type
Individual (NPI type 1)
Primary specialty
Mental Health Counselor 101YM0800X
Practice address
825 E Golf Rd
Suite 1127
Arlington Heights, IL 60005-5700
Phone
(847) 981-9200
NPI assigned
Jul 24, 2009
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare Care Compare profile

Specialty
Clinical Psychologist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3633 W Lake Ave
Suite 306
Glenview, IL 60026-5803
Phone (760) 831-1191

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20160127002297 IL Practitioner - Clinical Psychologist 2668775479 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes

Practice roles

OrganizationSpecialtyStatusNew patients
Amy Fayazrad & Associates, PC Current
since May 16, 2018
Accepting new patients

Locations

3633 W Lake Ave
Ste 306
Glenview, IL 60026
Phone (312) 285-4729

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Yes

Addresses

Primary practice location

825 E Golf Rd
Suite 1127
Arlington Heights, IL 60005-5700

Mailing address

825 E Golf Rd
Suite 1127
Arlington Heights, IL 60005-5700
Phone (847) 981-9200

Other providers in Arlington Heights, IL

All providers in Arlington Heights, IL · Mental Health Counselor in Illinois

Sources for this page

Verify at the official NPI Registry.