NPIMap

Organization Active NPI

Fly Radical Therapy, LLC

  • Professional Counselor
  • Chicago, IL
National Provider Identifier
1720745912
Registry record updated Nov 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
FLY RADICAL THERAPY, LLC
Practice address
2659 W Division St
Chicago, IL 60622-2851
Phone
(773) 469-0709
NPI assigned
Nov 22, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2021

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

Authorized official

Name
Dorian A. Ortega, LCPCNPI 1164837282
Title
Psychotherapist/ Owner
Phone
(773) 469-0709

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

2659 W Division St
Chicago, IL 60622-2851

Mailing address

1711 W Jarvis Ave
Chicago, IL 60626-1600
Phone (773) 469-0709

Other names 1

  • Dorian A. Ortega Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL info@flyradicaltherapy.com Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Locations

2659 W Division St
Chicago, IL 60622
Phone (312) 219-5780

Practitioners & affiliated clinicians

Practitioners 4

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": "1637539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637539200000",
    "number": "1720745912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 W JARVIS AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606261600",
            "telephone_number": "773-469-0709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2659 W DIVISION ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222851",
            "telephone_number": "773-469-0709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLY RADICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-22",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A",
        "authorized_official_last_name": "ORTEGA",
        "authorized_official_first_name": "DORIAN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST/ OWNER",
        "authorized_official_telephone_number": "773-469-0709",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@flyradicaltherapy.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2659 W Division St",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606222851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Dorian A. Ortega",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 22, 2021; 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.