NPIMap

Organization Active NPI

Visions for Change Counseling Center, PC

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1336357003
Registry record updated Mar 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071007563 Issued in IL
Legal business name
VISIONS FOR CHANGE COUNSELING CENTER, PC
Practice address
9510 S Constance Ave
Suite C6
Chicago, IL 60617-4700
Phone
(773) 510-0104
Fax
(773) 731-9711
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2009

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

Authorized official

Name
Richara C. Jennings, PSYD, LCPCNPI 1669545208
Title
Administrative Director
Phone
(773) 238-1992

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 071007563 IL Primary

Addresses

Primary practice location

9510 S Constance Ave
Suite C6
Chicago, IL 60617-4700

Mailing address

9510 S Constance Ave
Suite C6
Chicago, IL 60617-4700
Phone (773) 510-0104

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236902400000",
    "number": "1336357003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9510 S CONSTANCE AVE",
            "address_2": "SUITE C6",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174700",
            "telephone_number": "773-510-0104",
            "fax_number": "773-731-9711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9510 S CONSTANCE AVE",
            "address_2": "SUITE C6",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174700",
            "telephone_number": "773-510-0104",
            "fax_number": "773-731-9711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISIONS FOR CHANGE COUNSELING CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2009-03-13",
        "status": "A",
        "authorized_official_last_name": "JENNINGS",
        "authorized_official_first_name": "RICHARA",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "773-238-1992",
        "authorized_official_credential": "PSYD, LCPC"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071007563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2009; 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.