Mental Edge Counseling LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

180010099 Issued in IL

Legal business name

MENTAL EDGE COUNSELING LLC

Practice address

11106 Front St
Mokena, IL 60448-1587

Phone

(815) 953-2553

NPI assigned

Apr 24, 2016

Organization subpart

No

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

Authorized official

Name

Nathan Lagacy

Title

Owner

Phone

(815) 953-2553

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1461456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461456000000",
    "number": "1497100747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11106 FRONT ST",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604481587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11106 FRONT ST",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604481587",
            "telephone_number": "815-953-2553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL EDGE COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-24",
        "last_updated": "2016-04-24",
        "status": "A",
        "authorized_official_last_name": "LAGACY",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-953-2553"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "180010099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Mokena, IL
• Providers in Mokena, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2016; 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.