Origem Psychotherapy LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

ORIGEM PSYCHOTHERAPY LLC

Practice address

1300 W Belmont Ave Ste 300
Chicago, IL 60657-3200

Phone

(312) 219-2476

NPI assigned

Dec 11, 2021

Organization subpart

No

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

Authorized official

Name

Camila O. De Azevedo, LCPCNPI 1861875452

Title

Psychotherapist, Owner

Phone

(312) 219-2476

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Camila Oliveira De Azevedo, LCPC

  • Mental Health Counselor
  • Chicago, IL
  • NPI 1861875452
  NPD Authorized official

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

{
    "created_epoch": "1639180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1750040341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 W BELMONT AVE STE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606573200",
            "telephone_number": "312-219-2476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W BELMONT AVE STE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606573200",
            "telephone_number": "312-219-2476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORIGEM PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-11",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "DE AZEVEDO",
        "authorized_official_first_name": "CAMILA",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST, OWNER",
        "authorized_official_telephone_number": "312-219-2476",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Carlito Villabona Orig, MD
• Elizabeth Origer, PT, DPT
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• Bako Agnes Orionzi, MD

• Mental Health Counselor in Chicago, IL
• Providers in Chicago, 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 Dec 13, 2023; 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.