Jaime Chavez, LPC
Individual provider Active NPI Professional Counselor · Blue Island, IL
NPI 1285033274 · NPPES record last updated Aug 15, 2014
Key facts
- NPI
- 1285033274
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 178.010095 (IL)
- Practice address
- 13136 Western Ave
Blue Island, IL 60406-2423 - Phone
- (708) 974-5822
- NPI assigned
- Aug 15, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.010095 | IL | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.010095 | IL | Yes |
Addresses
Primary practice location
13136 Western Ave
Blue Island, IL 60406-2423
Mailing address
13136 Western Ave
Blue Island, IL 60406-2423
Phone (708) 974-5822
Other providers in Blue Island, IL
- Jonathan Cavanaugh
- Cynthia Cazares
- Paula K Celani
- Alfredo Cervantes
- Kanti Chaudhari
- Shilpa Cheela
- Bai Fan Chen
- Jean Chenoweth
- Belinda Childs
- Lee R Christensen
All providers in Blue Island, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.