Active NPI
Crystal Henderson
- Mental Health Counselor
- South Holland, IL
National Provider Identifier
1124519806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 401 E 162ND St Ste 103
South Holland, IL 60473-2237 - Phone
- (773) 819-5504
- NPI assigned
- May 29, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | IL | Primary |
Addresses
Primary practice location
401 E 162ND St Ste 103
South Holland, IL 60473-2237
Mailing address
401 E 162ND St Ste 103
South Holland, IL 60473-2237
Phone (773) 819-5504
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101YM0800X | Medicaid | IL |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healing Empowering & Learning Professionals LLC | 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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- South Holland, IL
- NPI 1023595675
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527552000000",
"number": "1124519806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 E 162ND ST STE 103",
"city": "SOUTH HOLLAND",
"state": "IL",
"postal_code": "604732237",
"telephone_number": "773-819-5504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 E 162ND ST STE 103",
"city": "SOUTH HOLLAND",
"state": "IL",
"postal_code": "604732237",
"telephone_number": "773-819-5504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "CRYSTAL",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-05-29",
"last_updated": "2018-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101YM0800X",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Holland, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.