NPIMap

Organization Active NPI

Authentic Connection Services PLLC

  • Professional Counselor
  • Chicago, IL
National Provider Identifier
1205600103
Registry record updated Nov 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
AUTHENTIC CONNECTION SERVICES PLLC
Practice address
1643 W Farragut Ave Apt 1
Chicago, IL 60640-0881
Phone
(314) 757-7241
NPI assigned
Nov 10, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2023

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

Authorized official

Name
Timothy Joseph Jordan, LCPCNPI 1801670153
Title
Owner/Manager
Phone
(314) 757-7241

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

1643 W Farragut Ave Apt 1
Chicago, IL 60640-0881

Mailing address

1643 W Farragut Ave Apt 1
Chicago, IL 60640-0881
Phone (314) 757-7241

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1699574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699574400000",
    "number": "1205600103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1643 W FARRAGUT AVE APT 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606400881",
            "telephone_number": "314-757-7241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1643 W FARRAGUT AVE APT 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606400881",
            "telephone_number": "314-757-7241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTHENTIC CONNECTION SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-10",
        "last_updated": "2023-11-10",
        "certification_date": "2023-11-10",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "314-757-7241",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2023; 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.