Individual provider Active NPI

Zoya Mirza

  • Mental Health Counselor
  • Lake Forest, IL
National Provider Identifier
1568180818
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
178020423 Issued in IL
Practice address
222 E Wisconsin Ave Ste 111E
Lake Forest, IL 60045-1700
Phone
(847) 445-6608
NPI assigned
Aug 22, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 178020423 IL Primary

Addresses

Primary practice location

222 E Wisconsin Ave Ste 111E
Lake Forest, IL 60045-1700

Mailing address

222 E Wisconsin Ave Ste 111E
Lake Forest, IL 60045-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241004000680 IL Practitioner - Mental Health Counselor 1052850021 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

276 E Deerpath Rd
Suite 647
Lake Forest, IL 60045-1940
Phone (847) 834-9647

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
178020423ILMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Z Holistic Connections PLLC CurrentSince May 1, 2024 Accepting new patients

Locations

222 E Wisconsin Ave
Ste 111E
Lake Forest, IL 60045
Phone (847) 445-6608

276 E Deerpath
Lake Forest, IL 60045
Phone (847) 834-9647

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": "1661126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1568180818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 E WISCONSIN AVE STE 111E",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 E WISCONSIN AVE STE 111E",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451700",
            "telephone_number": "847-445-6608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRZA",
        "first_name": "ZOYA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-22",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178020423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, IL

Sources for this page

Verify at the official NPI Registry.