Copertino Counseling Inc

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

180.009951 Issued in IL

Legal business name

COPERTINO COUNSELING INC

Practice address

526 Crescent Blvd
Glen Ellyn, IL 60137-4176

Phone

(630) 440-9013

NPI assigned

Jan 14, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Copertino, MS, LCPC

Title

Clinical Professional Counselor

Phone

(630) 440-9013

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452729600000",
    "number": "1174989552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 CRESCENT BLVD",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374176",
            "telephone_number": "630-440-9013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 CRESCENT BLVD",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374176",
            "telephone_number": "630-440-9013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPERTINO COUNSELING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-14",
        "last_updated": "2016-01-14",
        "status": "A",
        "authorized_official_last_name": "COPERTINO",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CLINICAL PROFESSIONAL COUNSELOR",
        "authorized_official_telephone_number": "630-440-9013",
        "authorized_official_credential": "MS, LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "IL",
            "license": "180.009951",
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "IL",
            "license": "180.009951",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Glen Ellyn, IL
• Providers in Glen Ellyn, IL by specialty
• Adult Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.