Active NPI
Blaise Fayolle
- Professional Counselor
- Chicago, IL
National Provider Identifier
1720579238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.013787
- Practice address
- 455 N Cityfront Plaza Dr
Chicago, IL 60611-5503 - Phone
- (312) 705-1503
- NPI assigned
- May 21, 2018
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.013787 | IL | Primary |
Addresses
Primary practice location
455 N Cityfront Plaza Dr
Chicago, IL 60611-5503
Mailing address
1927 N Honore St Apt 2B
Chicago, IL 60622-7560
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 |
|---|---|---|---|
| 178.013787 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526860800000",
"number": "1720579238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1927 N HONORE ST APT 2B",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606227560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 N CITYFRONT PLAZA DR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606115503",
"telephone_number": "312-705-1503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAYOLLE",
"first_name": "BLAISE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-21",
"last_updated": "2018-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.013787",
"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 21, 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.