Active NPI
Courtney Holden
- Professional Counselor
- Evergreen Park, IL
National Provider Identifier
1629532486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.014889
- Practice address
- 3317 W 95TH St
Evergreen Park, IL 60805-2243 - Phone
- (708) 529-3011
- NPI assigned
- Jan 25, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.013969 | IL | |
| Professional Counselor | 101YP2500X | 180.014889 | IL | Primary |
Addresses
Primary practice location
3317 W 95TH St
Evergreen Park, IL 60805-2243
Mailing address
1035 N Milwaukee Ave
Chicago, IL 60642-4181
Phone (312) 730-0366
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.013969 | IL | MD | Professional Counselor |
| 180.014889 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699660800000",
"number": "1629532486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1035 N MILWAUKEE AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606424181",
"telephone_number": "312-730-0366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3317 W 95TH ST",
"city": "EVERGREEN PARK",
"state": "IL",
"postal_code": "608052243",
"telephone_number": "708-529-3011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLDEN",
"first_name": "COURTNEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-25",
"last_updated": "2023-11-11",
"certification_date": "2023-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.013969",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.014889",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evergreen Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.