Active NPI
Racquel Reynolds
- Mental Health Counselor
- Chicago, IL
National Provider Identifier
1033946892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 845 W 69TH St
Chicago, IL 60621-1709 - Phone
- (773) 651-6809
- NPI assigned
- Sep 16, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
845 W 69TH St
Chicago, IL 60621-1709
Mailing address
9434 S Elizabeth St
Chicago, IL 60620-3611
Phone (773) 217-3102
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250707002028 | IL | Practitioner - Mental Health Counselor | 7416461173 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729728000000",
"number": "1033946892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9434 S ELIZABETH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606203611",
"telephone_number": "773-217-3102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "845 W 69TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606211709",
"telephone_number": "773-651-6809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "RACQUEL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-09-16",
"last_updated": "2024-10-24",
"certification_date": "2024-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.