Individual provider Active NPI

Yancy Cruz

  • Professional Counselor
  • Carbondale, IL
National Provider Identifier
1295147445
Registry record updated Dec 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180.016962 Issued in IL
Practice address
310 S Plover Dr
Carbondale, IL 62901-2030
Phone
(787) 372-4808
NPI assigned
May 22, 2014
Last updated
Dec 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 180.016962 IL Primary

Addresses

Primary practice location

310 S Plover Dr
Carbondale, IL 62901-2030

Mailing address

PO Box 3411
Carbondale, IL 62902-3411
Phone (787) 372-4808

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20251203002162 IL Practitioner - Mental Health Counselor 3476046988 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mental Health Specialty Group PAGroup PAC ID 8921466228, 726 clinicians

Practice addresses (Care Compare)

332 S Michigan Ave
Chicago, IL 60604-4301
Phone (323) 205-7088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
180.016962ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Mental Health CurrentSince Nov 22, 2025 Accepting new patients
Mental Health Specialty Group PA Mental Health CurrentSince Nov 20, 2025 Accepting new patients

Locations

332 S Michigan Ave
Chicago, IL 60604
Phone (773) 633-7479

605 N Michigan Ave
Fl 4
Chicago, IL 60611
Phone (773) 232-5338

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765411200000",
    "number": "1295147445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3411",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023411",
            "telephone_number": "787-372-4808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S PLOVER DR",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629012030",
            "telephone_number": "787-372-4808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUZ",
        "first_name": "YANCY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-22",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.016962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.