NPIMap

Organization Active NPI

Central Dupage Pastoral Counseling Center

  • Professional Counselor
  • Carol Stream, IL
National Provider Identifier
1063401206
Registry record updated Jun 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
CENTRAL DUPAGE PASTORAL COUNSELING CENTER
Practice address
507 Thornhill Dr
Suite a
Carol Stream, IL 60188-2706
Phone
(630) 752-9750
Fax
(630) 752-9768
NPI assigned
Oct 20, 2005
Last updated
Jun 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2021

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

Authorized official

Name
Mr. Nancy Cochran, PSYD
Title
Executive Director
Phone
(630) 752-9750

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Pastoral Counselor 101YP1600X
Professional Counselor 101YP2500X 178001992 IL
Professional Counselor 101YP2500X 180005369 IL
Professional Counselor 101YP2500X 180002208 IL
Professional Counselor 101YP2500X Primary
Clinical Psychologist 103TC0700X 178002569 IL
Clinical Psychologist 103TC0700X 071004746 IL
Clinical Psychologist 103TC0700X 071006345 IL
Clinical Psychologist 103TC0700X 071006372 IL
Marriage & Family Therapist 106H00000X

Addresses

Primary practice location

507 Thornhill Dr
Suite a
Carol Stream, IL 60188-2706

Mailing address

507 Thornhill Dr
Suite a
Carol Stream, IL 60188-2706
Phone (630) 752-9750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050408001039 IL Part B Supplier - Clinic/Group Practice 2769429950 Receives reassigned benefits from 4 practitioners
Practice locations: Carol Stream, IL

National Provider Directory

National Provider Directory

Locations

507 Thornhill Dr
Carol Stream, IL 60188
Phone (630) 752-9750

507 Thornhill Dr
Ste A
Carol Stream, IL 60188
Phone (630) 752-9750

386 Pennsylvania Ave
Ste 2N
Glen Ellyn, IL 60137
Phone 630858805615

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622678400000",
    "number": "1063401206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 THORNHILL DR",
            "address_2": "SUITE A",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882706",
            "telephone_number": "630-752-9750",
            "fax_number": "630-752-9768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 THORNHILL DR",
            "address_2": "SUITE A",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882706",
            "telephone_number": "630-752-9750",
            "fax_number": "630-752-9768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL DUPAGE PASTORAL COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A",
        "authorized_official_last_name": "COCHRAN",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "630-752-9750",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178001992",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180005369",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180002208",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "178002569",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071004746",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071006345",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071006372",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carol Stream, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.