Obsidian Holistic Services, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

OBSIDIAN HOLISTIC SERVICES, LLC

Practice address

930 175TH St Ste 1E
Homewood, IL 60430-2078

Phone

(708) 462-2134

NPI assigned

Aug 26, 2020

Last updated

Mar 23, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

SUGA BEAR CRAFTING ORGANIZATIONAs reported in NPPES

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

Authorized official

Name

Mrs. Erica Washington, MA, LCPC, LMHC, NCCNPI 1144620139

Title

Director of Operations

Phone

(708) 462-2134

Specialties & licenses 11

Addresses

Part of

Obsidian Institute of Integrative Medicine

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Erica Washington, MA, LPC, NCC

  • Mental Health Counselor
  • Harvey, IL
  • NPI 1144620139
  NPD Authorized official
• Diamond Nelson

  • Social Worker
  • Columbus, GA
  • NPI 1366824476
  NPD (past)

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

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679529600000",
    "number": "1801409008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 175TH ST STE 1E",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302078",
            "telephone_number": "708-462-2134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 175TH ST STE 1E",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302078",
            "telephone_number": "708-462-2134"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14741 Main St",
            "address_purpose": "LOCATION",
            "city": "Harvey",
            "state": "IL",
            "postal_code": "604261922",
            "country_code": "US",
            "telephone_number": "708-462-2134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OBSIDIAN HOLISTIC SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUGA BEAR CRAFTING ORGANIZATION",
        "enumeration_date": "2020-08-26",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "708-462-2134",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA, LCPC, LMHC, NCC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nuway Incorporated (Nuway Health Systems)
• Charity Nwaru, RN, MSN
• Jori Helen O'Connor, M.A., CCC-SLP, BCBA
• Kimberly Lynn O'Hara, PHARMD
• Kyla Shaneek O'Neal, LCPC
• Ocular Partners PLLC (Arbor Centers for Eyecare)
• Adesola Odedina
• Micere Oden
• Of Sound Mind Mental Health Counseling, Life Coaching, and Consultatio
• Christine A Offerman-Izzarelli, NURSE PRACTITIONER

• Mental Health Clinic/Center (Including Community Mental Health Center) in Homewood, IL
• Providers in Homewood, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.