Blazing Trails Counseling, PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

BLAZING TRAILS COUNSELING, PLLC

Practice address

15941 Harlem Ave # 140
Tinley Park, IL 60477-1609

Phone

(779) 435-4271

NPI assigned

Jul 7, 2020

Organization subpart

No

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

Authorized official

Name

Deanna L Stacy, MA, LCPC, NCCNPI 1558784942

Title

Owner/Therapist

Phone

(779) 435-4271

Specialties & licenses 1

Addresses

Practitioners 1

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

• Deanna L Stacy, MA, LCPC, NCC

  • Mental Health Counselor
  • Tinley Park, IL
  • NPI 1558784942
  NPD Authorized official

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

{
    "created_epoch": "1594080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595808000000",
    "number": "1770101784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15941 HARLEM AVE # 140",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771609",
            "telephone_number": "779-435-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15941 HARLEM AVE # 140",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771609",
            "telephone_number": "779-435-4271"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9435 Bormet Dr Ste 5",
            "address_purpose": "LOCATION",
            "city": "Mokena",
            "state": "IL",
            "postal_code": "604487401",
            "country_code": "US",
            "telephone_number": "779-435-4271",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLAZING TRAILS COUNSELING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-07",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A",
        "authorized_official_last_name": "STACY",
        "authorized_official_first_name": "DEANNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "779-435-4271",
        "authorized_official_credential": "MA, LCPC, NCC"
    },
    "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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• Jazmine Blair, RBT
• Peyton Blanchette, BCBA
• Angela Bleecher, DPT
• Cynthia A Blindauer, MSW, LCSW, ACSW
• Bob Rady, Inc
• Adeola Bamidele Bobade
• Susan Bobko, O.D.

• Mental Health Counselor in Tinley Park, IL
• Providers in Tinley Park, 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 Jul 27, 2020; 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.