Active NPI
Regina White
- Professional Counselor
- Gurnee, IL
National Provider Identifier
1174143671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.015702
- Practice address
- 1790 Nations Dr Ste 214
Gurnee, IL 60031-9176 - Phone
- (847) 868-3435
- Fax
- (847) 859-5885
- NPI assigned
- Apr 24, 2020
- Last updated
- Apr 24, 2020
- 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 | 178.015702 | IL | Primary |
Addresses
Primary practice location
1790 Nations Dr Ste 214
Gurnee, IL 60031-9176
Mailing address
175 E Hawthorn Pkwy Ste 235
Vernon Hills, IL 60061-1454
Phone (847) 868-3435
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 |
|---|---|---|---|
| 178.015702 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edgewood Clinical Services, P.C. | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587686400000",
"number": "1174143671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 E HAWTHORN PKWY STE 235",
"city": "VERNON HILLS",
"state": "IL",
"postal_code": "600611454",
"telephone_number": "847-868-3435",
"fax_number": "847-859-5885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1790 NATIONS DR STE 214",
"city": "GURNEE",
"state": "IL",
"postal_code": "600319176",
"telephone_number": "847-868-3435",
"fax_number": "847-859-5885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "REGINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-24",
"last_updated": "2020-04-24",
"certification_date": "2020-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.015702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gurnee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.