Active NPI
Justin Daniel Irvin, LPC
- Professional Counselor
- Warrenville, IL
National Provider Identifier
1437671963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.012940
- Practice address
- 28379 Davis Pkwy Ste 801
Warrenville, IL 60555-3032 - Phone
- (630) 300-4221
- NPI assigned
- Jul 17, 2017
- 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 | 178.012940 | IL | Primary |
Addresses
Primary practice location
28379 Davis Pkwy Ste 801
Warrenville, IL 60555-3032
Mailing address
1107 Briarbrook Dr Apt 2C
Wheaton, IL 60189-8654
Phone (309) 533-2251
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 |
|---|---|---|---|
| 178.012940 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ivy Lane Counseling | Professional | Past | 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": "1500249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500249600000",
"number": "1437671963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1107 BRIARBROOK DR APT 2C",
"city": "WHEATON",
"state": "IL",
"postal_code": "601898654",
"telephone_number": "309-533-2251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28379 DAVIS PKWY STE 801",
"city": "WARRENVILLE",
"state": "IL",
"postal_code": "605553032",
"telephone_number": "630-300-4221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IRVIN",
"first_name": "JUSTIN",
"middle_name": "DANIEL",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-17",
"last_updated": "2017-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.012940",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warrenville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.