Provider Demographics
NPI:1801228010
Name:BIGBY, BRANDON (LMFT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:BIGBY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000979106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist