Fandom Behavioral Health Clinic PLLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

FANDOM BEHAVIORAL HEALTH CLINIC PLLC

Practice address

564 W Randolph St Unit 820
Chicago, IL 60661-2218

Phone

(708) 789-5669

NPI assigned

Jan 2, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Larry Lee Woods Jr., MA, LCPC

Title

Professional Counselor

Phone

(803) 719-3237

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1672617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677801600000",
    "number": "1942913280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "564 W RANDOLPH ST UNIT 820",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606612218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "564 W RANDOLPH ST UNIT 820",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606612218",
            "telephone_number": "708-789-5669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANDOM BEHAVIORAL HEALTH CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-02",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A",
        "authorized_official_last_name": "WOODS",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PROFESSIONAL COUNSELOR",
        "authorized_official_telephone_number": "803-719-3237",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MA, LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin Fan, MD
• Betty Fan, D.O.
• Eugene Fan, MD
• James Fan
• Yichen Fan, MD
• Michael E. Fanelli, RN
• Celestia Fang
• David Fang, PHARMD
• Evelyn Fang
• Jacob Samson Fang, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 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.