Amy Bazelon LCPC, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

180.010546 Issued in IL

Legal business name

AMY BAZELON LCPC, LLC

Practice address

839 Moseley Rd
Highland Park, IL 60035-4635

Phone

(847) 707-5424

NPI assigned

Mar 13, 2018

Organization subpart

No

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

Authorized official

Name

Amy Bazelon, LCPCNPI 1578991972

Title

Member

Phone

(847) 707-5424

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Amy Bazelon, LCPC

  • Professional Counselor
  • Highland Park, IL
  • NPI 1578991972
  NPD Authorized official

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

{
    "created_epoch": "1520899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635379200000",
    "number": "1124521430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "839 MOSELEY RD",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600354635",
            "telephone_number": "847-432-8968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "839 MOSELEY RD",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600354635",
            "telephone_number": "847-707-5424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMY BAZELON LCPC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-13",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-27",
        "status": "A",
        "authorized_official_last_name": "BAZELON",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "847-707-5424",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "180.010546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Highland Park, IL
• Providers in Highland Park, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.