Active NPI
Demi C Andersen, MHP
- Mental Health Counselor
- Gurnee, IL
National Provider Identifier
1306583091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 1790 Nations Dr Ste 101-110
Gurnee, IL 60031-9164 - Phone
- (224) 201-1530
- NPI assigned
- May 16, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
1790 Nations Dr Ste 101-110
Gurnee, IL 60031-9164
Mailing address
108 E Washington St
Round Lake Park, IL 60073-3060
Phone (224) 201-1530
Other practice location 1
108 E Washington St
Round Lake Park, IL 60073-3060
Phone (224) 201-1530
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652659200000",
"number": "1306583091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 E WASHINGTON ST",
"city": "ROUND LAKE PARK",
"state": "IL",
"postal_code": "600733060",
"telephone_number": "224-201-1530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1790 NATIONS DR STE 101-110",
"city": "GURNEE",
"state": "IL",
"postal_code": "600319164",
"telephone_number": "224-201-1530"
}
],
"practiceLocations": [
{
"address_1": "108 E Washington St",
"address_purpose": "LOCATION",
"city": "Round Lake Park",
"state": "IL",
"postal_code": "600733060",
"country_code": "US",
"telephone_number": "224-201-1530",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ANDERSEN",
"first_name": "DEMI",
"middle_name": "C",
"credential": "MHP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-16",
"last_updated": "2022-05-16",
"certification_date": "2022-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gurnee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.