Active NPI
Jennifer D Nalls
- Professional Counselor
- Orland Park, IL
National Provider Identifier
1114503570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178014138
- Practice address
- 9641 W 153Rd St Ste 48
Orland Park, IL 60462-3777 - Phone
- (708) 963-0333
- NPI assigned
- Mar 24, 2021
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178014138 | IL | Primary |
Addresses
Primary practice location
9641 W 153Rd St Ste 48
Orland Park, IL 60462-3777
Mailing address
4644 Farmington Ave
Richton Park, IL 60471-1808
Phone (708) 747-5967
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 |
|---|---|---|---|
| 178014138 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thriving Lives Counseling, LLC | Professional | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616544000000",
"number": "1114503570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4644 FARMINGTON AVE",
"city": "RICHTON PARK",
"state": "IL",
"postal_code": "604711808",
"telephone_number": "708-747-5967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9641 W 153RD ST STE 48",
"city": "ORLAND PARK",
"state": "IL",
"postal_code": "604623777",
"telephone_number": "708-963-0333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NALLS",
"first_name": "JENNIFER",
"middle_name": "D",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-24",
"last_updated": "2021-03-24",
"certification_date": "2021-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178014138",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orland Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.