Bright Star Community Outreach

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.008564 Issued in IL

Legal business name

BRIGHT STAR COMMUNITY OUTREACH

Practice address

4518 S Cottage Grove Ave
Chicago, IL 60653-4395

Phone

(773) 373-5220

Fax

(312) 982-2566

NPI assigned

Dec 28, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Cynthia Langley, PSY.D.

Title

Clinical Supervisor

Phone

(309) 645-5445

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1482883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482883200000",
    "number": "1568907616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3473 S KING DR",
            "address_2": "SUITE 334",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606164108",
            "telephone_number": "773-373-5220",
            "fax_number": "312-982-2566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4518 S COTTAGE GROVE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606534395",
            "telephone_number": "773-373-5220",
            "fax_number": "312-982-2566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHT STAR COMMUNITY OUTREACH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-28",
        "last_updated": "2016-12-28",
        "status": "A",
        "authorized_official_last_name": "LANGLEY",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "CLINICAL SUPERVISOR",
        "authorized_official_telephone_number": "309-645-5445",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.008564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; 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.