Tracey Elena Tillis

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1414 Main St
Melrose Park, IL 60160-3902

Phone

(708) 681-0073

NPI assigned

Jun 30, 2023

Last updated

Jun 30, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1688083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1376220350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 S 25TH AVE",
            "city": "BROADVIEW",
            "state": "IL",
            "postal_code": "601553960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 MAIN ST",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601603902",
            "telephone_number": "708-681-0073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLIS",
        "first_name": "TRACEY",
        "middle_name": "ELENA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-30",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "tracey082697@gmail.com",
            "affiliation": "Y",
            "endpointDescription": "issue identifier",
            "affiliationName": "Presence Behavioral Health",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "1414 Main St",
            "city": "Melrose Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601603902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Melrose Park, IL
• Providers in Melrose Park, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.