NPIMap

Organization Active NPI

Black Tie Therapy

  • Community/Behavioral Health Agency
  • Chicago, IL
National Provider Identifier
1073156196
Registry record updated Sep 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
BLACK TIE THERAPY
Practice address
2232 N Wayne Ave Apt 1F
Chicago, IL 60614-8937
Phone
(773) 217-8426
NPI assigned
Oct 21, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2020

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

Authorized official

Name
Myron Nelson, LCPCNPI 1689083776
Title
President
Phone
(216) 832-1907

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
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

2232 N Wayne Ave Apt 1F
Chicago, IL 60614-8937

Mailing address

2232 N Wayne Ave Apt 1F
Chicago, IL 60614-8937

Electronic endpoints 3

TypeEndpointUseAffiliation
CONNECT URL myron@blacktietherapy.com Direct
CONNECT URL myron@blacktietherapy.com Direct
CONNECT URL myron@blacktietherapy.com Direct

National Provider Directory

National Provider Directory

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": "1571616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599177600000",
    "number": "1073156196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2232 N WAYNE AVE APT 1F",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606148937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2232 N WAYNE AVE APT 1F",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606148937",
            "telephone_number": "773-217-8426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK TIE THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-21",
        "last_updated": "2020-09-04",
        "certification_date": "2020-09-04",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "MYRON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-832-1907",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "myron@blacktietherapy.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2232 N Wayne Ave Apt 1F",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606148937",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "myron@blacktietherapy.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2232 N Wayne Ave Apt 1F",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606148937",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "myron@blacktietherapy.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2232 N Wayne Ave Apt 1F",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606148937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Sep 4, 2020; 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.