Julia Jordan-Lake

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

178.015637 Issued in IL

Practice address

7421 Madison St
Forest Park, IL 60130-1575

Phone

(615) 975-2774

NPI assigned

Jan 17, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Pop Pediatric Therapy Services, LLC

  • Pediatric Occupational Therapist
  • Forest Park, IL
  • NPI 1639733959
  NPD (past)

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

{
    "created_epoch": "1579219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579478400000",
    "number": "1447880513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 N CUYLER AVE APT 2R",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603022378",
            "telephone_number": "615-975-2774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7421 MADISON ST",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601301575",
            "telephone_number": "615-975-2774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN-LAKE",
        "first_name": "JULIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-17",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.015637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra L Jensen, L. AC.
• Jerry E Udelson, DDS, PC (Little Teeth Big Smiles & Children's Dentistry)
• Jin Wu PSYD LLC
• Christine Johnson, APN
• Laneta Chanelle Johnson, DT
• Joseph & Brooks Family Therapy LLC
• Julie E Josler, LCPC
• Kalina Pain Institute
• Jared Allan Kalina, DO
• Atima Kamra, DDS

• Mental Health Counselor in Forest Park, IL
• Providers in Forest 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 Jan 20, 2020; 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.