Active NPI
Patrice L Henderson, M.S.
- Rehabilitation Counselor
- Chicago, IL
National Provider Identifier
1043501117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Counselor
- License
- 00105739
- Practice address
- 33 E 114TH St
Chicago, IL 60628-4921 - Phone
- (773) 660-4630
- Fax
- (773) 660-4650
- NPI assigned
- Apr 25, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Rehabilitation Counselor | 225C00000X | 00105739 | IL | Primary |
Addresses
Primary practice location
33 E 114TH St
Chicago, IL 60628-4921
Mailing address
33 E 114TH St
Chicago, IL 60628-4921
Phone (773) 660-4630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00105739 | IL | MD | Rehabilitation Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Modern Insight Therapy PLLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Professional Counselor
- Chicago, IL
- NPI 1215568480
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335916800000",
"number": "1043501117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 E 114TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606284921",
"telephone_number": "773-660-4630",
"fax_number": "773-660-4650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 E 114TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606284921",
"telephone_number": "773-660-4630",
"fax_number": "773-660-4650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "PATRICE",
"middle_name": "L",
"credential": "M.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-25",
"last_updated": "2012-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "225C00000X",
"taxonomy_group": "",
"desc": "Rehabilitation Counselor",
"state": "IL",
"license": "00105739",
"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 May 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.