Basic Information
| Provider Information | |||||||||
| NPI: | 1134189392 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAY | ||||||||
| FirstName: | ERIKA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MA, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 S MICHIGAN AVE | ||||||||
| Address2: | B-390 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606162333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125672295 | ||||||||
| FaxNumber: | 3123287895 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 S MICHIGAN AVE | ||||||||
| Address2: | B-390 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606162333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125672295 | ||||||||
| FaxNumber: | 3123287895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IL | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 01621679 | 01 | IL | BCBS OF IL | OTHER |