Olalekan Olumuyiwa Fasogbon, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209.032300 Issued in IL

Practice address

10935 S Halsted St
Chicago, IL 60628-3127

Phone

(773) 419-0138

NPI assigned

Apr 30, 2025

Last updated

Aug 13, 2025By the provider in NPPES

Sex

Male

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

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ear to Ear Behavioral Health SolutionsGroup PAC ID 3274922018, 3 clinicians

Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.olalekanfasogbon@146897.advancedmd-direct.com

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

• Ear to Ear Behavioral Health Solutions

  • Adult Mental Health Clinic/Center
  • Chicago, IL
  • NPI 1467023150
  Medicare reassignment Care Compare group NPD
• Edgewood Clinical Services, P.C.

  dba LifeStance

  • Psychologist
  • Naperville, IL
  • NPI 1295914646

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• Rajiv Kandala M D S C

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1114094281
  Medicare reassignment NPD
• Southside Primary Care Group SC

  dba Metro Medical Associates

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1417403072
  Medicare reassignment NPD
• Impeccable Grace Services PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
  • NPI 1598677502
  Authorized official Same address or phone
• Psychology Specialists LTD

  dba LifeStance Health

  • Clinical Psychologist
  • Bloomington, IL
  • NPI 1053368605
  NPD (past)

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

{
    "created_epoch": "1745971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755043200000",
    "number": "1487442158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11724 S JUSTINE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606435028",
            "telephone_number": "773-419-0138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10935 S HALSTED ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606283127",
            "telephone_number": "773-419-0138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FASOGBON",
        "first_name": "OLALEKAN",
        "middle_name": "OLUMUYIWA",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-04-30",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209.032300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald Fary, OD
• Clarissa Fasbender
• Jo M Fasen, MPT, OCS, CSCS, MDT
• Brian Joseph Fask, LCSW
• Ariana Cristina Faso, DNP, CPNP-PC
• Ofer Fass, MD
• Meghan Lively Fasseas
• Fast and Friendly Transportation LLC
• Jennifer L Fast, PT
• Fastrad Chicago LLC

• Psychiatric/Mental Health Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.