Individual provider Active NPI

Christy Thielen

  • Professional Counselor
  • Chicago, IL
National Provider Identifier
1083104897
Registry record updated Dec 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180.013938 Issued in IL
Practice address
1209 W Diversey Pkwy Unit G-2
Chicago, IL 60614-1201
Phone
(773) 236-8566
NPI assigned
May 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 178.010029 IL
Professional Counselor 101YP2500X 180.013938 IL Primary

Addresses

Primary practice location

1209 W Diversey Pkwy Unit G-2
Chicago, IL 60614-1201

Mailing address

1209 W Diversey Pkwy Unit G-2
Chicago, IL 60614-1201
Phone (773) 236-8566

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
I20240807002500 IL Practitioner - Mental Health Counselor 6507303617 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1209 W Diversey Pkwy
Unit G 2
Chicago, IL 60614-1201
Phone (773) 236-8566

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
178.010029ILMDProfessional Counselor
180.013938ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Renew You Counseling Center LLC CurrentSince Sep 1, 2024 Accepting new patients

Locations

3257 N Sheffield Ave
Ste 118
Chicago, IL 60657
Phone (309) 868-3654

1209 W Diversey Pkwy
Unit G2
Chicago, IL 60614
Phone (773) 236-8566

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.

NPI Registry JSON

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

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1083104897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 W DIVERSEY PKWY UNIT G-2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141201",
            "telephone_number": "773-236-8566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 W DIVERSEY PKWY UNIT G-2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141201",
            "telephone_number": "773-236-8566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIELEN",
        "first_name": "CHRISTY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-16",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.010029",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.013938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.