Carolyn Suzette Champion, EDD CADC THD

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

20997 Issued in IL

Practice address

2215 W 95TH St
Chicago, IL 60643-1001

Phone

(773) 819-0646

NPI assigned

Mar 26, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mokl Mokl Mokl Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1467089573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9105 S HARPER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606197917",
            "telephone_number": "773-550-5591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 W 95TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606431001",
            "telephone_number": "773-819-0646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPION",
        "first_name": "CAROLYN",
        "middle_name": "SUZETTE",
        "name_prefix": "Dr.",
        "credential": "EDD CADC THD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-26",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "20997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "mokconsulting.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2215 W 95th St",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606431001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MOKL",
            "last_name": "MOKL",
            "middle_name": "MOKL",
            "credential": "EDD CADC THD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Rebeca Chamorro
• Emily Champa
• Alexandria Champagne, LCSW
• Kathryn Champagne, OTR/L
• Champion Management Group
• Chams Women'S Health Care, SC
• Albert N Chams, M.D.
• Abbas A Chamsuddin, M.D.
• Alexander Howai Chan, DDS
• Anthony Chan, RPH.

• Mental Health Counselor in Chicago, IL
• Providers in Chicago, 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 Mar 26, 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.