Active NPI
Paul Brouwer
- Professional Counselor
- Chicago, IL
National Provider Identifier
1285353060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178018258
- Practice address
- 4740 N Clark St
Chicago, IL 60640-4689 - Phone
- (773) 769-0205
- NPI assigned
- Aug 24, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178018258 | IL | Primary |
Addresses
Primary practice location
4740 N Clark St
Chicago, IL 60640-4689
Mailing address
1430 N Dearborn St Apt 206
Chicago, IL 60610-5543
Phone (616) 558-7454
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178018258 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661299200000",
"number": "1285353060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1430 N DEARBORN ST APT 206",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606105543",
"telephone_number": "616-558-7454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4740 N CLARK ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606404689",
"telephone_number": "773-769-0205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUWER",
"first_name": "PAUL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-24",
"last_updated": "2022-08-24",
"certification_date": "2022-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178018258",
"primary": true
}
],
"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 Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.