Radical Healing Psychotherapy PLLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

RADICAL HEALING PSYCHOTHERAPY PLLC

Practice address

1514 W Pratt Blvd Apt 3B
Chicago, IL 60626-4234

Phone

(813) 943-5255

NPI assigned

Aug 23, 2024

Organization subpart

No

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

Authorized official

Name

Frederick Cary Shepard, LCPCNPI 1598316291

Title

Member

Phone

(813) 943-5255

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.

• Frederick Cary Shepard, LPC

  • Counselor
  • Chicago, IL
  • NPI 1598316291
  NPD Authorized official

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

{
    "created_epoch": "1724371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1932932969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 W PRATT BLVD APT 3B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606264234",
            "telephone_number": "813-943-5255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 W PRATT BLVD APT 3B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606264234",
            "telephone_number": "813-943-5255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADICAL HEALING PSYCHOTHERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-23",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "SHEPARD",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "CARY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "813-943-5255",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Radial Health SC
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• Radical Authenticity & Wellness Psychotherapy Group LLC
• Radical Realness Therapy PLLC
• Radical Resilience, LLC
• Radicallyblended Services
• George A Radich, MD
• Kimberly Radich, MS, RD, LDN

• Adult Mental Health Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Adult Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; 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.