Eauly Brautigam, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.012335 Issued in IL

Practice address

18640 Belvidere Road
Grayslake, IL 60030

Phone

(847) 548-6000

NPI assigned

Oct 22, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Youth Network, Inc

  • Mental Health Counselor
  • Grayslake, IL
  • NPI 1518098771
  NPD (past)

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

{
    "created_epoch": "1287705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1831499052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2244 NICHOLS RD APT D",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600041149",
            "telephone_number": "773-225-4832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18640 BELVIDERE ROAD",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "60030",
            "telephone_number": "847-548-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6918 Windsor Ave",
            "address_purpose": "LOCATION",
            "city": "Berwyn",
            "state": "IL",
            "postal_code": "604023334",
            "country_code": "US",
            "telephone_number": "708-745-5277 x3525",
            "fax_number": "708-795-4834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRAUTIGAM",
        "first_name": "EAULY",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-22",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.012335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Grayslake, IL
• Providers in Grayslake, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; 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.