Jennifer Mally, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180004361 Issued in IL

Practice address

1227 N Honore St
3
Chicago, IL 60622-3119

Phone

(773) 540-9261

Fax

(773) 540-9261

NPI assigned

Oct 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mental Health Center of East Central Kansas a CorporationGroup PAC ID 2163498122, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jennifermally@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mental Health Center of East Central Kansas a Corporation

  dba CrossWinds Counseling and Wellness

  • Community/Behavioral Health Agency
  • Emporia, KS
  • NPI 1740365758
  Medicare reassignment Care Compare group
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Professional

  NPD

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1225121353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1227 N HONORE ST",
            "address_2": "3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606223119",
            "telephone_number": "773-540-9261",
            "fax_number": "773-540-9261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 N HONORE ST",
            "address_2": "3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606223119",
            "telephone_number": "773-540-9261",
            "fax_number": "773-540-9261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLY",
        "first_name": "JENNIFER",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180004361",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KS",
            "license": "LCPC03478",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Telice Mallory
• Colleen A Malloy, MD
• Kelly Malloy
• Phillip J Malloy, PT
• Riley Shannon Malloy, MS
• Eric Christopher Malm, LCSW
• Stacy Malm, LCPC
• Casey Malman
• Alyse Malmborg, MA
• Meghan Malmquist, BCAT, RBT, B.S. B.A.

• Professional Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.