NPIMap

Organization Active NPI

Black Excellence Psychotherapy PLLC

  • Adolescent and Children Mental Health Clinic/Center
  • Lake Bluff, IL
National Provider Identifier
1700539681
Registry record updated Oct 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
BLACK EXCELLENCE PSYCHOTHERAPY PLLC
Practice address
30047 N Waukegan Rd
Lake Bluff, IL 60044-1023
Phone
(718) 342-4986
NPI assigned
Jan 31, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2022

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

Authorized official

Name
Fitzgerald AjokuNPI 1104583418
Title
Founder
Phone
(914) 609-1183

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

30047 N Waukegan Rd
Lake Bluff, IL 60044-1023

Mailing address

30047 N Waukegan Rd
Lake Bluff, IL 60044-1023

National Provider Directory

National Provider Directory

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665878400000",
    "number": "1700539681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30047 N WAUKEGAN RD",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "600441023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30047 N WAUKEGAN RD",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "600441023",
            "telephone_number": "718-342-4986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK EXCELLENCE PSYCHOTHERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-31",
        "last_updated": "2022-10-16",
        "certification_date": "2022-10-16",
        "status": "A",
        "authorized_official_last_name": "AJOKU",
        "authorized_official_first_name": "FITZGERALD",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "914-609-1183"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Bluff, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2022; 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.