Active NPI
Elisa Renee Jellen, L.PC
- Professional Counselor
- Glen Carbon, IL
National Provider Identifier
1689902645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2009009733
- Practice address
- 30 Grainey Dr
Glen Carbon, IL 62034-3217 - Phone
- (618) 205-3615
- NPI assigned
- Dec 2, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2009009733 | MO | Primary |
Addresses
Primary practice location
30 Grainey Dr
Glen Carbon, IL 62034-3217
Mailing address
30 Grainey Dr
Glen Carbon, IL 62034-3217
Phone (618) 205-3615
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 |
|---|---|---|---|
| 2009009733 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1259712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259712000000",
"number": "1689902645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 GRAINEY DR",
"city": "GLEN CARBON",
"state": "IL",
"postal_code": "620343217",
"telephone_number": "618-205-3615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 GRAINEY DR",
"city": "GLEN CARBON",
"state": "IL",
"postal_code": "620343217",
"telephone_number": "618-205-3615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JELLEN",
"first_name": "ELISA",
"middle_name": "RENEE",
"name_prefix": "Ms.",
"credential": "L.PC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-12-02",
"last_updated": "2009-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2009009733",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Carbon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.