Jonathan Cavanaugh
Individual provider Active NPI Professional Counselor · Blue Island, IL
NPI 1629374202 · NPPES record last updated Dec 23, 2014
Key facts
- NPI
- 1629374202
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 180.008799 (IL)
- Practice address
- 12145 Western Ave
Blue Island, IL 60406-1387 - Phone
- (773) 432-6236
- NPI assigned
- Jan 31, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- CMC Healthcare LLC
Practice addresses (Care Compare)
1251 E Richton Rd
Crete, IL 60417-1623
Phone (708) 672-6700
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240910003204 | IL | Practitioner - Mental Health Counselor | 5698215291 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.008799 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CMC Healthcare LLC | Current |
Accepting new patients |
Locations
2451 W Touhy Ave
Chicago, IL 60645
Phone (312) 593-5599
1251 E Richton Rd
Crete, IL 60417
Phone (708) 367-4414
2201 Main St
Evanston, IL 60202
Phone (847) 905-3000
19000 Halsted St
Homewood, IL 60430
Phone (708) 957-5161
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.008799 | IL | Yes |
Addresses
Primary practice location
12145 Western Ave
Blue Island, IL 60406-1387
Mailing address
12145 Western Ave
Blue Island, IL 60406-1387
Other providers in Blue Island, IL
- Marina Cajas
- Brenda Carbajal
- Loretta Carpenter
- Natalie Renee Casey
- Julliana Castaneda
- Cynthia Cazares
- Paula K Celani
- Alfredo Cervantes
- Kanti Chaudhari
- Jaime Chavez
All providers in Blue Island, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.