Mary Theis, MA, CSLG PSY LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.004853 Issued in IL

Practice address

9343 Drake Ave
Evanston, IL 60203-1406

Phone

(847) 677-7022

NPI assigned

Jan 12, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Clinical Psychologist

Education

Other, 1977

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1452556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452556800000",
    "number": "1366808974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9343 DRAKE AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602031406",
            "telephone_number": "847-677-7022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9343 DRAKE AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602031406",
            "telephone_number": "847-677-7022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEIS",
        "first_name": "MARY",
        "credential": "MA, CSLG PSY  LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-12",
        "last_updated": "2016-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.004853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Jan 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.