NPIMap

Organization Active NPI

Tides Mental Health of Il, PLLC

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1154014116
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
TIDES MENTAL HEALTH OF IL, PLLC
Practice address
3000 N Halsted St Ste 803
Chicago, IL 60657-6185
Phone
(312) 391-6845
NPI assigned
May 26, 2023
Last updated
Dec 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

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

Authorized official

Name
Reginald Richardson, LCSWNPI 1508904962
Title
Owner
Phone
(312) 391-6845

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

3000 N Halsted St Ste 803
Chicago, IL 60657-6185

Mailing address

3000 N Halsted St Ste 803
Chicago, IL 60657-6185
Phone (312) 391-6845

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230720004147 IL Part B Supplier - Clinic/Group Practice 4789044884 Receives reassigned benefits from 6 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

620 N La Salle Dr
Ste 426
Chicago, IL 60654

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1685059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734566400000",
    "number": "1154014116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 N HALSTED ST STE 803",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606576185",
            "telephone_number": "312-391-6845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 N HALSTED ST STE 803",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606576185",
            "telephone_number": "312-391-6845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDES MENTAL HEALTH OF IL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-26",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "REGINALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-391-6845",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.