Individual provider Active NPI

Denise McNicholas, LCPC

  • Mental Health Counselor
  • Bolingbrook, IL
National Provider Identifier
1639931793
Registry record updated Sep 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
180.002856 Issued in IL
Practice address
213 Periwinkle LN
Bolingbrook, IL 60490-4552
Phone
(630) 806-6225
NPI assigned
Jan 24, 2024
Last updated
Sep 26, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2025

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 180.002856 IL Primary

Addresses

Primary practice location

213 Periwinkle LN
Bolingbrook, IL 60490-4552

Mailing address

213 Periwinkle LN
Bolingbrook, IL 60490-4552
Phone (630) 806-6225

Other practice location 1

230 Martin Ave
Naperville, IL 60540-6536
Phone (630) 848-1200

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
I20251202003448 IL Practitioner - Mental Health Counselor 8022500107 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prizm Behavioral Services, PCGroup PAC ID 8729147806, 4 clinicians

Practice addresses (Care Compare)

230 W Martin Ave
Naperville, IL 60540-6536
Phone (630) 848-1200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
180.002856ILMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Prizm Behavioral Services, PC CurrentSince Nov 14, 2025 Accepting new patients
Lifeskills Counseling Services, LLC PastSince Sep 5, 2023 Accepting new patients

Locations

230 Martin Ave
Naperville, IL 60540
Phone (630) 369-6299

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1706054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758844800000",
    "number": "1639931793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 PERIWINKLE LN",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604904552",
            "telephone_number": "630-806-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 PERIWINKLE LN",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604904552",
            "telephone_number": "630-806-6225"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "230 Martin Ave",
            "address_purpose": "LOCATION",
            "city": "Naperville",
            "state": "IL",
            "postal_code": "605406536",
            "country_code": "US",
            "telephone_number": "630-848-1200",
            "fax_number": "630-848-1208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCNICHOLAS",
        "first_name": "DENISE",
        "name_prefix": "Ms.",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-24",
        "last_updated": "2025-09-26",
        "certification_date": "2025-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.002856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

Verify at the official NPI Registry.