PHILIP ANDREW DOHERTY
NPI 1720835432
Counselor in Forest Park, IL

Q: What is Philip Doherty's NPI number?

The NPI number for Philip Doherty is 1720835432. It was assigned to this individual provider in the NPPES registry on May 1, 2024.

Q: What is Philip Doherty's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

Q: Is Philip Doherty enrolled in Medicare?

No. Philip Doherty has opted out of Medicare through December 8, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Philip Doherty was last updated on June 6, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 01, 2024Opted out of Medicare · through Dec 8, 2027

7621 ROOSEVELT RD, FOREST PARK, IL 60130(773) 234-0423 Get Directions Write a Review

NPPES record last updated: June 6, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 6, 2024, May 1, 2024 (2 updates tracked since 2024).

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About Philip Andrew Doherty NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PHILIP ANDREW DOHERTY (NPI 1720835432) is an individual counselor in Forest Park, Illinois and active in the NPI registry since May 2024. He has opted out of Medicare through December 8, 2027.

NPPES Registry Identity

NPI1720835432

Entity TypeIndividualMale

Primary Taxonomy101Y00000X

Provider Legal NamePHILIP ANDREW DOHERTY

Location Address7621 ROOSEVELT RDForest Park, IL 60130-2212

Mailing Address827 Sherman Ave Apt 3Evanston, IL 60202-4926 · (206) 512-4861

Phone(773) 234-0423

Sole ProprietorYes

Enumeration DateMay 1, 2024

Last NPPES UpdateJune 6, 20242 updates tracked since enumeration

NPPES CertifiedJune 6, 2024

✔ NPI 1720835432 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers

Taxonomy Code101Y00000X

Definition

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

7621 ROOSEVELT RD, Forest Park, IL 60130

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Philip Andrew Doherty has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 8, 2025 through December 8, 2027.

Opt-Out Effective DateDecember 8, 2025

Opt-Out In Effect ThroughDecember 8, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MEEAE KING

Counselor (Mental Health)