Emerson Black, MA, LPC, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

178.020205 Issued in IL

Practice address

217 Glenwood Ave
Willow Springs, IL 60480-1307

Phone

(574) 283-0438

NPI assigned

Mar 1, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: emerson.black.1@23300.direct.athenahealth.com

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

• Willow Therapeutic, PLLC

  • Mental Health Counselor
  • Willow Springs, IL
  • NPI 1801581848
  NPD (past)

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

{
    "created_epoch": "1709251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1689431199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8461",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606080461",
            "telephone_number": "512-944-2979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 GLENWOOD AVE",
            "city": "WILLOW SPRINGS",
            "state": "IL",
            "postal_code": "604801307",
            "telephone_number": "574-283-0438"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "130 N La Grange Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "LA Grange",
            "state": "IL",
            "postal_code": "605252004",
            "country_code": "US",
            "telephone_number": "708-325-8454",
            "fax_number": "888-647-5310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "EMERSON",
        "credential": "MA, LPC, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-01",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.020205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kimberly Hope Brock, LMSW
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• Soohyun Jessica Chon, PHARM.D

• Professional Counselor in Willow Springs, IL
• Providers in Willow Springs, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.