Jennifer Lynn Black, LCPC, CCMHC, LBS1

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180011432 Issued in IL

Practice address

1125 Cleveland St
Evanston, IL 60202

Phone

(224) 830-9800

NPI assigned

Dec 30, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 7, 2024 through May 7, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1230595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527033600000",
    "number": "1336385103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 CLEVELAND ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602022114",
            "telephone_number": "224-830-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 CLEVELAND ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "60202",
            "telephone_number": "224-830-9800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 W Schaumburg Rd",
            "address_2": "Suite 68803",
            "address_purpose": "LOCATION",
            "city": "Schaumburg",
            "state": "IL",
            "postal_code": "601943365",
            "country_code": "US",
            "telephone_number": "331-200-9701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2550 Crawford Ave",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602014900",
            "country_code": "US",
            "telephone_number": "224-830-9800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "LCPC, CCMHC, LBS1",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-30",
        "last_updated": "2018-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180011432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruth Ann Bittner, MSW
• BK Dental-Evanston LLC
• Black Chiropractic PC (Black Chiropractic & Family Wellness Center)
• Constance Ann Black, DC
• Danielle Anna Black, PH.D.
• Jonella Renee Black, PT
• Miranda Brooke Blackburn
• Noel L. Blackburn, LCSW, PH.D.
• Brittney Johanna Blackwell, APN-CNP
• Kayla Blakey, MA, CRC, LPC

• Professional Counselor in Evanston, IL
• Providers in Evanston, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.