NPIMap

Organization Active NPI

Clinical Assist, LTD.

Doing business as Black Bear Academy

  • Clinical Child & Adolescent Psychologist
  • Chicago, IL
National Provider Identifier
1518246255
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Legal business name
CLINICAL ASSIST, LTD.
Doing business as
Black Bear Academy
Practice address
1801 W Byron St
Chicago, IL 60613-2729
Phone
(773) 244-0700
Fax
(773) 244-0200
NPI assigned
Aug 11, 2011
Last updated
Jan 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

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

Authorized official

Name
Dr. Lori G Tall, PSYDNPI 1750308524
Title
Executive Director
Phone
(312) 285-2323

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X Primary
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X
Early Intervention Provider Agency 252Y00000X 060006146 IL

Addresses

Primary practice location

1801 W Byron St
Chicago, IL 60613-2729

Mailing address

1801 W Byron St
Chicago, IL 60613-2729
Phone (773) 244-0700

Other names 1

  • Black Bear Academy Doing business as

National Provider Directory

National Provider Directory

Locations

1801 W Byron St
Chicago, IL 60613
Phone (773) 244-0500

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1313020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610323200000",
    "number": "1518246255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 W BYRON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132729",
            "telephone_number": "773-244-0700",
            "fax_number": "773-244-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W BYRON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132729",
            "telephone_number": "773-244-0700",
            "fax_number": "773-244-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL ASSIST, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-11",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A",
        "authorized_official_last_name": "TALL",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "312-285-2323",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "IL",
            "license": "060006146",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Black Bear Academy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Black Bear Academy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 11, 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.