Brooke Petersen Counseling PLLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

BROOKE PETERSEN COUNSELING PLLC

Practice address

3609 N Magnolia Ave
Chicago, IL 60613-3820

Phone

(630) 803-1062

NPI assigned

May 11, 2021

Last updated

May 11, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brooke N Petersen, LCPCNPI 1982108874

Title

Psychotherapist

Phone

(630) 803-1062

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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.

• Brooke Noel Petersen, LPC

  • Professional Counselor
  • Chicago, IL
  • NPI 1982108874
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620691200000",
    "number": "1154905651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "547 S CLARK ST APT 1001",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606051547",
            "telephone_number": "630-803-1062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3609 N MAGNOLIA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606133820",
            "telephone_number": "630-803-1062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKE PETERSEN COUNSELING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-11",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "630-803-1062",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCPC",
            "identifier": "180013512",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "SimplePractice",
            "affiliation": "N",
            "address_1": "3609 N Magnolia Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606133820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Brookdale Senior Living
• Brookdale Senior Living Inc
• Heidi Sharon Brookenthal, D.O.
• Jay M Brooker, MD
• Sarah M Brooker, MD, PHD
• Brookhaven Counseling Group, LLC
• Krystal Brookins, LPC

• Professional Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; 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.