Active NPI
Phyllis Barnes Booth, MA, LMFT, LCPC.
- Marriage & Family Therapist
- Chicago, IL
National Provider Identifier
1366831588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 166-000-152
- Practice address
- 5550 So. South Shore Drive
#1415
Chicago, IL 60637 - Phone
- (773) 753-4674
- NPI assigned
- Jan 12, 2015
- Last updated
- Jan 12, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180-000-574 | IL | |
| Marriage & Family Therapist | 106H00000X | 166-000-152 | IL | Primary |
Addresses
Primary practice location
5550 So. South Shore Drive
#1415
Chicago, IL 60637
Mailing address
5550 South South Shore Drive
#1415
Chicago, IL 60637
Phone (773) 753-4674
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180-000-574 | IL | MD | Professional Counselor |
| 166-000-152 | IL | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421020800000",
"number": "1366831588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5550 SOUTH SOUTH SHORE DRIVE",
"address_2": "#1415",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60637",
"telephone_number": "773-753-4674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5550 SO. SOUTH SHORE DRIVE",
"address_2": "#1415",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60637",
"telephone_number": "773-753-4674"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTH",
"first_name": "PHYLLIS",
"middle_name": "BARNES",
"name_prefix": "Mrs.",
"credential": "MA, LMFT, LCPC.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-01-12",
"last_updated": "2015-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180-000-574",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "IL",
"license": "166-000-152",
"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 Jan 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.