NPIMap

Organization Active NPI

Blueprint

  • Mental Health Counselor
  • Urbana, IL
National Provider Identifier
1265736110
Registry record updated Feb 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
180.006836 Issued in IL
Legal business name
BLUEPRINT
Practice address
2704 Boulder Drive
Suite B
Urbana, IL 61802
Phone
(217) 469-9300
Fax
(217) 469-9301
NPI assigned
Jan 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2013

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

Authorized official

Name
Ms. Gina K Johnson, LCSWNPI 1306069836
Title
Owner/Therapist
Phone
(217) 469-9300

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 180.006836 IL Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 149.009378 IL

Addresses

Primary practice location

2704 Boulder Drive
Suite B
Urbana, IL 61802

Mailing address

2704 Boulder Drive
Suite B
Urbana, IL 61802
Phone (217) 469-9300

Other names 1

  • JMP Counseling & Tutoring Services Former legal business name

National Provider Directory

National Provider Directory

Locations

510 Devonshire Dr
Ste F
Champaign, IL 61820
Phone (217) 607-1678

2704 Boulder Dr
Ste B
Urbana, IL 61802
Phone (217) 469-9300

Practitioners & affiliated clinicians

Practitioners 2

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": "1294358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361923200000",
    "number": "1265736110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2704 BOULDER DRIVE",
            "address_2": "SUITE B",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61802",
            "telephone_number": "217-469-9300",
            "fax_number": "217-469-9301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2704 BOULDER DRIVE",
            "address_2": "SUITE B",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61802",
            "telephone_number": "217-469-9300",
            "fax_number": "217-469-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEPRINT",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-07",
        "last_updated": "2013-02-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "217-469-9300",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.006836",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.009378",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JMP Counseling & Tutoring Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Urbana, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; 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.