Individual provider Active NPI

Elena Jenkins

  • Mental Health Counselor
  • East Peoria, IL
National Provider Identifier
1013620723
Registry record updated Dec 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
111 W Washington St Ste 230
East Peoria, IL 61611-2560
Phone
(309) 477-5607
NPI assigned
Dec 28, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

111 W Washington St Ste 230
East Peoria, IL 61611-2560

Mailing address

111 W Washington St Ste 230
East Peoria, IL 61611-2560
Phone (309) 477-5607

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250609000997 IL Practitioner - Mental Health Counselor 1153831268 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3248 Vandever Ave
Pekin, IL 61554-6257
Phone (309) 347-5522

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Tazwood Mental Health Center, Inc. Mental Health CurrentSince Mar 7, 2025 Accepting new patients
Tazwood Mental Health Center, Inc. CurrentSince Mar 7, 2025 Accepting new patients

Locations

111 W Washington St
Ste 230
East Peoria, IL 61611
Phone (309) 694-6462

3248 Vandever Ave
Pekin, IL 61554
Phone (309) 347-5522

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1672185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1013620723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W WASHINGTON ST STE 230",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616112560",
            "telephone_number": "309-477-5607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W WASHINGTON ST STE 230",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616112560",
            "telephone_number": "309-477-5607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "ELENA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-28",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Peoria, IL

Sources for this page

Verify at the official NPI Registry.