Active NPI
Maria Fakhouri, PSYD
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1063229417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071011351
- Practice address
- 333 N Michigan Ave Ste 2400
Chicago, IL 60601-4040 - Phone
- (773) 609-0361
- Fax
- (312) 896-5595
- NPI assigned
- Dec 18, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071011351 | IL | Primary |
Addresses
Primary practice location
333 N Michigan Ave Ste 2400
Chicago, IL 60601-4040
Mailing address
540 N State St Apt 2911
Chicago, IL 60654-7237
Phone (312) 636-7486
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 6, 2025 through Jan 6, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071011351 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1734480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734480000000",
"number": "1063229417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "540 N STATE ST APT 2911",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606547237",
"telephone_number": "312-636-7486"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 N MICHIGAN AVE STE 2400",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606014040",
"telephone_number": "773-609-0361",
"fax_number": "312-896-5595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAKHOURI",
"first_name": "MARIA",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-12-18",
"last_updated": "2024-12-18",
"certification_date": "2024-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071011351",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.