Tracey Latonya Blackburn

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1717 Rand Rd
Des Plaines, IL 60016-3509

Phone

(773) 294-5797

NPI assigned

Sep 10, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Catholic Charities of the Archdiocese of Chicago

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
  • NPI 1669583001
  NPD (past)

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

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1629551304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 N HERMITAGE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606221161",
            "telephone_number": "773-294-5797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 RAND RD",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600163509",
            "telephone_number": "773-294-5797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "TRACEY",
        "middle_name": "LATONYA",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-10",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362170821061",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsay Nicole Bishop, BA
• Flair Olvis Bitancor
• Adam Bixby, PHARMD
• BKD Personal Assistance Services LLC (Brookdale at Home Des Plaines)
• Tina Fruscione Blachut, D.O.
• Kathleen Leslie Blaha, LPC
• Kyle Cox Blair, DO
• Michael P Blair, M.D.
• Blare House Inc. (The Visions Network)
• BLC-the Heritage of Des Plaines, LLC (Brookdale Des Plaines)

• Mental Health Counselor in Des Plaines, IL
• Providers in Des Plaines, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2018; 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.