Healthcare Provider Details

I. General information

NPI: 1407656986
Provider Name (Legal Business Name): MONTY FAIDLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N MICHIGAN AVE STE 2400
CHICAGO IL
60601-4040
US

IV. Provider business mailing address

333 N MICHIGAN AVE STE 2400
CHICAGO IL
60601-4040
US

V. Phone/Fax

Practice location:
  • Phone: 773-609-0361
  • Fax:
Mailing address:
  • Phone: 773-609-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.021933
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number208.011442
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: