Allyssa Rose Bertram, LCPC CADC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

180.012157 Issued in IL

Practice address

4055 W Peterson Ave Ste 202
Chicago, IL 60646-6183

Phone

(773) 774-4444

NPI assigned

Sep 17, 2020

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Urban Wellness, LTD.

  • Professional Counselor
  • Chicago, IL
  • NPI 1942565353

  Single Specialty

  NPD

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

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1366058075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 DEMPSTER ST APT E105",
            "city": "MOUNT PROSPECT",
            "state": "IL",
            "postal_code": "600566154",
            "telephone_number": "440-452-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 W PETERSON AVE STE 202",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606466183",
            "telephone_number": "773-774-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTRAM",
        "first_name": "ALLYSSA",
        "middle_name": "ROSE",
        "credential": "LCPC CADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-17",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": "IL",
            "license": "180.012157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCPC",
            "identifier": "180.012157",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "allyssa@urbanwellnesscounseling.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4055 W Peterson Ave Ste 202",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606466183",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sam Bertling, LAC
• Charles Norman Bertoia, O.D
• Adria Bertolini, APN
• Elizabeth Berton
• Bertram Kraft, MD, SC
• Madeline Bertram, CCC-SLP
• Lakiesha Robin Bertrand
• Marcel Bertsch-Gout, MD
• Elizabeth C Bertsch, M.D.
• Marco Bertucci Zoccali, MD

• All providers in Chicago, IL
• Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.