Fukari Psych, PLLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

FUKARI PSYCH, PLLC

Practice address

10 N Lake St Ste 109
Grayslake, IL 60030-3636

Phone

(815) 479-4140

NPI assigned

Jul 11, 2024

Last updated

Jul 11, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Shelley Marie Johnson, LCPCNPI 1942680251

Title

Therapist/Owner

Phone

(815) 479-4140

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

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.

• Shelley Johnson

  • Mental Health Counselor
  • Waukegan, IL
  • NPI 1942680251
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1720656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1851138325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3204 BISCAYNE RD",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508321",
            "telephone_number": "815-236-8836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 N LAKE ST STE 109",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600303636",
            "telephone_number": "815-479-4140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUKARI PSYCH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-11",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "THERAPIST/OWNER",
        "authorized_official_telephone_number": "815-479-4140",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Christine Fox, MA
• Jenifer Marie Frechette, MSW
• Fresenius Medical Care Chicagoland, LLC (Fresenius Kidney Care Grayslake)
• Cassidy Jordyn Friedman, M.A. CCC-SLP
• Lindsey Frystak, BA
• Jenna M Fulks, PT, DPT
• Functional Performance Chiropractic, LTD
• G G Family Dental Care PC
• John N Gaetano, M.D.
• Edward J Galarza Jr., BS PT

• 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 Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.