Active NPI
Tracey C Adams, LCPC
- Mental Health Counselor
- South Holland, IL
National Provider Identifier
1164587275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 180005780
- Practice address
- 16162 Ellis Ave
Unit 1 South
South Holland, IL 60473-1700 - Phone
- (708) 331-4101
- Fax
- (708) 331-4755
- NPI assigned
- Dec 27, 2006
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 180005780 | IL | Primary |
Addresses
Primary practice location
16162 Ellis Ave
Unit 1 South
South Holland, IL 60473-1700
Mailing address
1440 Tanglewood St Unit 4C
Flossmoor, IL 60422-1765
Phone (708) 331-4101
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 |
|---|---|---|---|
| 180005780 | IL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332374400000",
"number": "1164587275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1440 TANGLEWOOD ST UNIT 4C",
"city": "FLOSSMOOR",
"state": "IL",
"postal_code": "604221765",
"telephone_number": "708-331-4101",
"fax_number": "708-331-4755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16162 ELLIS AVE",
"address_2": "UNIT 1 SOUTH",
"city": "SOUTH HOLLAND",
"state": "IL",
"postal_code": "604731700",
"telephone_number": "708-331-4101",
"fax_number": "708-331-4755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADAMS",
"first_name": "TRACEY",
"middle_name": "C",
"name_prefix": "Ms.",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-27",
"last_updated": "2012-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "180005780",
"primary": true
}
],
"identifiers": [],
"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 Mar 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.