Provider Demographics
NPI:1407226103
Name:BRANDON BIGBY, LMFT, LLC
Entity Type:Organization
Organization Name:BRANDON BIGBY, LMFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGBY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:773-564-9763
Mailing Address - Street 1:5100 N RAVENSWOOD AVE
Mailing Address - Street 2:SUITE 217
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2713
Mailing Address - Country:US
Mailing Address - Phone:773-564-9763
Mailing Address - Fax:773-250-3575
Practice Address - Street 1:5100 N RAVENSWOOD AVE
Practice Address - Street 2:SUITE 217
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2713
Practice Address - Country:US
Practice Address - Phone:773-564-9763
Practice Address - Fax:773-250-3575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000979106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty