Individual provider Active NPI

Kelly Warren, LPC, ALMFT

  • Professional Counselor
  • Chicago, IL
National Provider Identifier
1407663628
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
178.020818 Issued in IL
Practice address
1147 W Ohio St
Chicago, IL 60642-6472
Phone
(312) 772-9796
NPI assigned
Dec 11, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 178.020818 IL Primary

Addresses

Primary practice location

1147 W Ohio St
Chicago, IL 60642-6472

Mailing address

7229 S Evans Ave
Chicago, IL 60619-1224

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

LicenseStateTypeSpecialty
178.020818ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Optimum Joy, P.C. Professional PastSince Jul 31, 2022 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.

NPI Registry JSON

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

{
    "created_epoch": "1733875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1407663628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7229 S EVANS AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606191224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1147 W OHIO ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606426472",
            "telephone_number": "312-772-9796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "KELLY",
        "credential": "LPC, ALMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-11",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.020818",
            "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 11, 2024; 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.