Briyanna Bullock, M.ED, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

178017357 Issued in IL

Practice address

636 Church St Ste 619
Evanston, IL 60201-4586

Phone

(847) 864-0600

NPI assigned

Sep 14, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jennifer C. Panning PSYD PC

  • Clinical Psychologist
  • Evanston, IL
  • NPI 1326440454
  NPD (past)

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

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1245900034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4555 N SHERIDAN RD APT 407",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST STE 619",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014586",
            "telephone_number": "847-864-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "BRIYANNA",
        "credential": "M.ED, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-14",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178017357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Livia Adia Budrys, LCSW
• Anh Que Bui, M.D.
• Fatima Z Bukhari, O.D.
• Lauren Kathleen Bulgarelli
• Blake A Bullock, LCSW
• Zachary B. Bulwa, MD, MS
• Rebecca Bunn
• Elizabeth Buonauro
• Karen L. Burey, P.T.
• Ivelisse Burgo, PSYD, LPC, NCC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.