Tina M Jerolds

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

149.010409 Issued in IL

Practice address

15 Green Acres LN
Jonesboro, IL 62952-1325

Phone

(618) 697-3834

NPI assigned

Jul 12, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1003540576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 GREEN ACRES LN",
            "city": "JONESBORO",
            "state": "IL",
            "postal_code": "629521325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 GREEN ACRES LN",
            "city": "JONESBORO",
            "state": "IL",
            "postal_code": "629521325",
            "telephone_number": "618-697-3834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEROLDS",
        "first_name": "TINA",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-12",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "149.010409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Adams
• County of Union
• G&G Behavioral Health Consultants LLC
• Cody Hubble, DPT
• Brady Jiter
• Jonesboro CC School Dist 43
• Jonesboro School District 43
• Lincoln Square
• Jimmie R Livesay, BCBA

• Mental Health Counselor in Jonesboro, IL
• Providers in Jonesboro, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.