Active NPI
Breon Rose
- Mental Health Counselor
- Chicago, IL
National Provider Identifier
1639605827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 178.012335
- Practice address
- 1427 W Farwell Ave
3S
Chicago, IL 60626-3426 - Phone
- (517) 944-5250
- NPI assigned
- May 7, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 178.012335 | IL | Primary |
Addresses
Primary practice location
1427 W Farwell Ave
3S
Chicago, IL 60626-3426
Mailing address
1427 W Farwell Ave
3S
Chicago, IL 60626-3426
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.012335 | IL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494115200000",
"number": "1639605827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1427 W FARWELL AVE",
"address_2": "3S",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606263426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1427 W FARWELL AVE",
"address_2": "3S",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606263426",
"telephone_number": "517-944-5250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "BREON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-05-07",
"last_updated": "2017-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "178.012335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 May 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.