Active NPI
Jessica Mata
- Counselor
- Crystal Lake, IL
National Provider Identifier
1053126094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 178.021255
- Practice address
- 800 S McHenry Ave Ste F
Crystal Lake, IL 60014-7487 - Phone
- (815) 526-3750
- Fax
- (815) 526-3440
- NPI assigned
- Feb 7, 2025
- Last updated
- Feb 7, 2025
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 178.021255 | IL | Primary |
Addresses
Primary practice location
800 S McHenry Ave Ste F
Crystal Lake, IL 60014-7487
Mailing address
800 McHenry Ave.
Suite F
Crystal Lake, IL 60014
Phone (815) 526-3750
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.021255 | IL | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738886400000",
"number": "1053126094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 MCHENRY AVE.",
"address_2": "SUITE F",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "60014",
"telephone_number": "815-526-3750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 S MCHENRY AVE STE F",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600147487",
"telephone_number": "815-526-3750",
"fax_number": "815-526-3440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATA",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-02-07",
"last_updated": "2025-02-07",
"certification_date": "2025-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IL",
"license": "178.021255",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.