Camelle Burlock, LCPC
Individual provider Active NPI Professional Counselor · Lockport, IL
NPI 1164078341 · NPPES record last updated Jan 24, 2025
Key facts
- NPI
- 1164078341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 180013913 (IL)
- Practice address
- 16221 W 159TH St Ste 102
Lockport, IL 60441-7902 - Phone
- (847) 868-3435
- Fax
- (847) 859-5885
- NPI assigned
- Aug 14, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240918002086 | IL | Practitioner - Mental Health Counselor | 5991246936 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178014890 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edgewood Clinical Services, P.C. | Current |
Accepting new patients | |
| Psychology Specialists LTD | Past | Accepting new patients |
Locations
808 S Eldorado Rd
Ste 102
Bloomington, IL 61704
Phone (309) 212-6007
20550 S Lagrange Rd
Ste 105
Frankfort, IL 60423
Phone (708) 448-3300
16221 W 159th St
Ste 102
Lockport, IL 60441
Phone (331) 529-7699
3027 English Rows Ave
Ste 201
Naperville, IL 60564
2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165
175 E Hawthorne Pkwy
Ste 235
Vernon Hills, IL 60061
Phone (847) 865-4125
Interoperability endpoints
- lifestancehealth.camelleburlock@146897.advancedmd-direct.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178014890 | IL | |
| Professional Counselor | 101YP2500X | 180013913 | IL | Yes |
Addresses
Primary practice location
16221 W 159TH St Ste 102
Lockport, IL 60441-7902
Mailing address
175 E Hawthorn Pkwy Ste 235
Vernon Hills, IL 60061-1454
Phone (847) 737-8768
Other providers in Lockport, IL
- Lisa Michele Brown
- Brian Bruckner
- Kimberly Ann Brumley
- Lauren Bruns
- Bun Siu L Co, MD, SC
- Amanda Cantore
- Carevia LLC
- Darlene Marie Carlson
- Lisa Carlson
- Agnes Grace Cashen
All providers in Lockport, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.