=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023241486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIKA C. FAY, MA., LMFT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2009
-----------------------------------------------------
Last Update Date | 07/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3139 N LINCOLN AVE SUITE 202
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-3114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-425-6652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3139 N LINCOLN AVE SUITE 202
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-3114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | MS. ERIKA FAY
-----------------------------------------------------
Credential | MA., LMFT
-----------------------------------------------------
Telephone | 773-425-6652
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 166-000571
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------