Waterbrook Therapy, Inc.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

WATERBROOK THERAPY, INC.

Practice address

10540 S Western Ave Ste 406
Chicago, IL 60643-2529

Phone

(773) 559-5958

Fax

(773) 442-0085

NPI assigned

Feb 27, 2019

Last updated

Feb 27, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert Preston Stanford, LCPCNPI 1366700155

Title

Owner

Phone

(312) 725-0646

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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.

• Robert Preston Stanford, LCPC

  • Professional Counselor
  • Frankfort, IL
  • NPI 1366700155
  NPD Authorized official

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

{
    "created_epoch": "1551225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551225600000",
    "number": "1528525383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10540 S WESTERN AVE STE 406",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606432529",
            "telephone_number": "773-559-5958",
            "fax_number": "773-442-0085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10540 S WESTERN AVE STE 406",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606432529",
            "telephone_number": "773-559-5958",
            "fax_number": "773-442-0085"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "166 W Washington St Ste 350",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606022353",
            "country_code": "US",
            "telephone_number": "773-559-5958",
            "fax_number": "773-442-0085",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WATERBROOK THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-27",
        "last_updated": "2019-02-27",
        "status": "A",
        "authorized_official_last_name": "STANFORD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "PRESTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-725-0646",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "354789452001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nadia Waterman, LPC

• Professional Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; 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.