Active NPI
Derek Vincent, LCPC
- Professional Counselor
- Chicago, IL
National Provider Identifier
1376199075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180012640
- Practice address
- 1263 W Loyola Ave
Chicago, IL 60626-6537 - Phone
- (773) 274-4600
- NPI assigned
- Aug 18, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180012640 | IL | Primary |
Addresses
Primary practice location
1263 W Loyola Ave
Chicago, IL 60626-6537
Mailing address
1632 Riverview Ave
Des Plaines, IL 60018-2263
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180012640 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Grief Recovery and Sibling Loss | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Chicago, IL
- NPI 1316046386
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577318400000",
"number": "1376199075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1632 RIVERVIEW AVE",
"city": "DES PLAINES",
"state": "IL",
"postal_code": "600182263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1263 W LOYOLA AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606266537",
"telephone_number": "773-274-4600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VINCENT",
"first_name": "DEREK",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-18",
"last_updated": "2019-12-26",
"certification_date": "2019-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180012640",
"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 Dec 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.