Individual provider Active NPI

Malekapukharajbanu P Qureshi, LCPC

  • Professional Counselor
  • Chicago, IL
National Provider Identifier
1033712666
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180-014619 Issued in IL
Practice address
6904 N Clark St
Chicago, IL 60626-3209
Phone
(312) 479-0288
NPI assigned
Nov 17, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 102048 IL
Professional Counselor 101YP2500X 180-014619 IL Primary

Addresses

Primary practice location

6904 N Clark St
Chicago, IL 60626-3209

Mailing address

9148 W Church St Apt 1a
Des Plaines, IL 60016-5028
Phone (312) 479-0288

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
I20241023000592 IL Practitioner - Mental Health Counselor 2466985999 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Truecare24 Physicians Group, S.C.Group PAC ID 7012308802, 26 clinicians

Practice addresses (Care Compare)

111 W Jackson Blvd
Chicago, IL 60604-3589
Phone (855) 227-3574

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
102048ILMDCounselor
180-014619ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Truecare24 Physicians Group, S.C. Professional CurrentSince Oct 4, 2024 Accepting new patients
Allied Benefit Care Services Inc. CurrentSince Nov 1, 2020 Accepting new patients

Locations

8270 Woodland Center Blvd
Tampa, FL 33614
Phone (305) 449-9219

111 W Jackson Blvd
Chicago, IL 60604
Phone (312) 251-2300

6904 N Clark St
Chicago, IL 60626
Phone (312) 479-0288

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": "1605571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1033712666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9148 W CHURCH ST APT 1A",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600165028",
            "telephone_number": "312-479-0288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6904 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606263209",
            "telephone_number": "312-479-0288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QURESHI",
        "first_name": "MALEKAPUKHARAJBANU",
        "middle_name": "P",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-17",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "102048",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180-014619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.