Active NPI
Jacqueline Davis, LCPC, LMHC
- Mental Health Counselor
- Schererville, IN
National Provider Identifier
1174848535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 39002046A
- Practice address
- 7403 Cline Ave
Schererville, IN 46375-2645 - Phone
- (219) 322-8614
- Fax
- (219) 322-8502
- NPI assigned
- Mar 29, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 180.006831 | IL | |
| Mental Health Counselor | 101YM0800X | 39002046A | IN | Primary |
Addresses
Primary practice location
7403 Cline Ave
Schererville, IN 46375-2645
Mailing address
7403 Cline Ave
Schererville, IN 46375-2645
Phone (219) 322-8614
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 |
|---|---|---|---|
| 180.006831 | IL | MD | Counselor |
| 39002046A | IN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269820800000",
"number": "1174848535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7403 CLINE AVE",
"city": "SCHERERVILLE",
"state": "IN",
"postal_code": "463752645",
"telephone_number": "219-322-8614",
"fax_number": "219-322-8502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7403 CLINE AVE",
"city": "SCHERERVILLE",
"state": "IN",
"postal_code": "463752645",
"telephone_number": "219-322-8614",
"fax_number": "219-322-8502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JACQUELINE",
"name_prefix": "Ms.",
"credential": "LCPC, LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-03-29",
"last_updated": "2010-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IL",
"license": "180.006831",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "39002046A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Schererville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.