1. Home
  2. Directory
  3. Illinois
  4. Chicago
  5. Counselor
  6. NPI Profile

FANDOM BEHAVIORAL HEALTH CLINIC PLLC
NPI 1942913280
Counselor - Professional in Chicago, IL

Active since January 02, 2023
564 W RANDOLPH ST UNIT 820, CHICAGO, IL 60661(708) 789-5669 Get Directions Write a Review

NPPES record last updated: March 3, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 3, 2023, Jan 2, 2023 (2 updates tracked since 2023).

About Fandom Behavioral Health Clinic Pllc NPPES

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

FANDOM BEHAVIORAL HEALTH CLINIC PLLC (NPI 1942913280) is a healthcare organization registered as a professional in Chicago, Illinois and active in the NPI registry since January 2023. The organization lists Larry Lee Woods, Professional Counselor, as its authorized official.

NPPES Registry Identity

NPI1942913280
Entity TypeOrganization
Primary Taxonomy101YP2500X
Legal Business NameFANDOM BEHAVIORAL HEALTH CLINIC PLLC
Location Address564 W RANDOLPH ST UNIT 820Chicago, IL 60661-2218
Mailing Address564 W Randolph St Unit 820Chicago, IL 60661-2218
Phone(708) 789-5669
Organization SubpartNo
Authorized OfficialLarry Lee WoodsProfessional Counselor · (803) 719-3237
Enumeration DateJanuary 2, 2023
Last NPPES UpdateMarch 3, 20232 updates tracked since enumeration
NPPES CertifiedMarch 3, 2023
✔ NPI 1942913280 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
564 W RANDOLPH ST UNIT 820, Chicago, IL 60661
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fandom Behavioral Health Clinic PLLC's NPI number?

The NPI number for Fandom Behavioral Health Clinic PLLC is 1942913280. It was assigned to this organization in the NPPES registry on January 2, 2023.

Where is Fandom Behavioral Health Clinic PLLC located?

Fandom Behavioral Health Clinic PLLC is located at 564 W Randolph St Unit 820, Chicago, IL 60661. The listed phone number is (708) 789-5669.

What is Fandom Behavioral Health Clinic PLLC's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

When was this NPI record last updated?

The NPPES record for Fandom Behavioral Health Clinic PLLC was last updated on March 3, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.