Jessica Michelle Bulthouse, M.S., LCPC
Individual provider Active NPI Professional Counselor · Charleston, IL
NPI 1659620458 · NPPES record last updated May 18, 2015
Key facts
- NPI
- 1659620458
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 180009706 (IL)
- Practice address
- 304 8TH St
Charleston, IL 61920-1504 - Phone
- (217) 508-7415
- NPI assigned
- Sep 7, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.008309 | IL | MD | Professional Counselor |
| 180009706 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Journey Professional Counseling LLC | Professional | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.008309 | IL | |
| Professional Counselor | 101YP2500X | 180009706 | IL | Yes |
Addresses
Primary practice location
304 8TH St
Charleston, IL 61920-1504
Mailing address
311 W Main St
Oakland, IL 61943-7109
Phone (217) 508-7415
Other providers in Charleston, IL
- Brinkerhoff Counseling LLC
- Amanda J Brinkerhoff
- Kaleb Lee Brown
- Garrett B Buell
- Sarah Buhnerkempe
- John H Bulthouse Jr.
- Teresa A Byars Patterson
- April C Callaway
- Bryan K Callaway
- Reagan Carey
All providers in Charleston, 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 May 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.