NPIMap

Organization Active NPI

Center for Change & Healing

  • Clinical Social Worker
  • Burr Ridge, IL
National Provider Identifier
1003570565
Registry record updated Oct 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
CENTER FOR CHANGE & HEALING
Practice address
11S230 S Jackson St Ste 104
Burr Ridge, IL 60527-7099
Phone
(630) 712-6042
NPI assigned
Oct 29, 2021
Last updated
Oct 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2021

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

Authorized official

Name
Mr. Kevin Kell, LCSWNPI 1023595238
Title
Director of Information
Phone
(630) 849-6212

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

11S230 S Jackson St Ste 104
Burr Ridge, IL 60527-7099

Mailing address

11S230 S Jackson St Ste 104
Burr Ridge, IL 60527-7099
Phone (630) 712-6042

National Provider Directory

National Provider Directory

Locations

11S230 S Jackson St
Ste 104
Burr Ridge, IL 60527
Phone (630) 712-6042

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635465600000",
    "number": "1003570565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11S230 S JACKSON ST STE 104",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605277099",
            "telephone_number": "630-712-6042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11S230 S JACKSON ST STE 104",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605277099",
            "telephone_number": "630-712-6042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR CHANGE & HEALING",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-29",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A",
        "authorized_official_last_name": "KELL",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "DIRECTOR OF INFORMATION",
        "authorized_official_telephone_number": "630-849-6212",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burr Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; 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.