Individual provider Active NPI

Jessica Williams, LPC

  • Professional Counselor
  • Dekalb, IL
National Provider Identifier
1043951908
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
178.017437 Issued in IL
Practice address
631 S 1St St
Dekalb, IL 60115-4117
Phone
(157) 568-5018
NPI assigned
Apr 5, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 178.017437 IL Primary

Addresses

Primary practice location

631 S 1St St
Dekalb, IL 60115-4117

Mailing address

PO Box 1109
Dekalb, IL 60115-7109
Phone (157) 564-8758

Other identifiers 1

IdentifierTypeStateIssuer
474579189001MedicaidIL

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
I20241025003302 IL Practitioner - Mental Health Counselor 5991238180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dekalb Behavioral Health Foundation, Inc.Group PAC ID 9436451655, 20 clinicians

Practice addresses (Care Compare)

631 S 1St St
Dekalb, IL 60115-4117
Phone (815) 756-8501

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
178.017437ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Dekalb Behavioral Health Foundation, Inc. CurrentSince Jul 19, 2024 Accepting new patients
Dekalb Behavioral Health Foundation, Inc. Current Accepting new patients
Dekalb Behavioral Health Foundation, Inc. CurrentSince Jul 19, 2024 Accepting new patients

Locations

12 Health Services Dr
DeKalb, IL 60115
Phone (815) 756-4875

631 S 1st St
DeKalb, IL 60115
Phone (815) 756-4875

Organizations & group practices 3

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": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1043951908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1109",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601157109",
            "telephone_number": "157-564-8758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 S 1ST ST",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601154117",
            "telephone_number": "157-568-5018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JESSICA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.017437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "474579189001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dekalb, IL

Sources for this page

Verify at the official NPI Registry.