Samantha Mizock, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180.016678 Issued in IL

Practice address

1550 N Northwest Hwy Ste 360
Park Ridge, IL 60068-1461

Phone

(847) 299-3400

NPI assigned

Sep 1, 2022

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1661990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1255051892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 N NORTHWEST HWY STE 360",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681461",
            "telephone_number": "847-299-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 N NORTHWEST HWY STE 360",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681461",
            "telephone_number": "847-299-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIZOCK",
        "first_name": "SAMANTHA",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-01",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "IL",
            "license": "596721",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.016678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mobile Diagnostic Solutions, Inc
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• Mental Health Counselor in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; 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.