Autumn Healthcare of Illinois
Organization Active NPI Mental Health Counselor · Chicago, IL
NPI 1679628705 · NPPES record last updated Apr 23, 2025
Key facts
- NPI
- 1679628705
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Legal business name
- AUTUMN HEALTHCARE OF ILLINOIS
- Practice address
- 4505 S Drexel Blvd
Chicago, IL 60653-4301 - Phone
- (773) 285-0550
- NPI assigned
- Jan 25, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Pamela Ann Brazelton-Sykes, MS
- Title
- Executive Director
- Phone
- (773) 420-3481
Corporate family (same tax ID) 1
Practitioners 14
-
Annie Wallace Hudson, L.C.S.W.
-
Steven E Hurley, PSY.D.
-
Lisa Lindsey-Robinson, LCSW
-
Akilah Baker, LCSW
-
Cristina Noel Betances, LCSW
-
Sheila McCowan Donovan, PH.D., M.S.W.
-
Richenel Samuel Ellecom, PSY.D; DR.P.H
-
Keenan Ferrell, PSY.D.
-
Felicia R. Madlock, MSW
-
Augustine Sohn, LCSW
-
Carmel P. Browne, LCSW, LICSW
-
Thomas Desmarais, LCSW
-
John Gary Grow, PH.D.
-
Steven David Zell, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040123000202 | IL | Part B Supplier - Clinic/Group Practice | 5991607624 |
Receives reassigned benefits from 3 practitioners Practice locations: Chicago, IL; Evergreen Park, IL |
National Provider Directory
- Tax ID family
- Autumn Healthcare of Illinois
Locations
6250 S Park Shore East Ct
Chicago, IL 60637
Phone (773) 955-7053
3800 S King Dr
Chicago, IL 60653
Phone (773) 420-4100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | Yes |
Addresses
Primary practice location
4505 S Drexel Blvd
Chicago, IL 60653-4301
Mailing address
9449 S Kedzie Ave
Ste142
Evergreen Park, IL 60805-2325
Phone (773) 420-3481
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487709697 | Other | IL | NPI |
| 207655 | Other | IL | NO TITLE |
Other providers in Chicago, IL
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- Autismchicago
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- Addie Auyeung
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All providers in Chicago, IL · Mental Health 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 Apr 23, 2025. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.