Active NPI
Jennifer Lara, LCPC
- Mental Health Counselor
- Chicago, IL
National Provider Identifier
1700115268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 180.007386
- Practice address
- 10725 S Western Ave
2ND Floor
Chicago, IL 60643-3135 - Phone
- (773) 251-8016
- NPI assigned
- Dec 12, 2009
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 180.007386 | IL | Primary |
Addresses
Primary practice location
10725 S Western Ave
2ND Floor
Chicago, IL 60643-3135
Mailing address
3770 W 75TH PL
Chicago, IL 60652-1337
Phone (773) 251-8016
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 21, 2024 through Mar 21, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.007386 | IL | MD | Mental Health Counselor |
| 180014068 | IL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280361600000",
"number": "1700115268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3770 W 75TH PL",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606521337",
"telephone_number": "773-251-8016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10725 S WESTERN AVE",
"address_2": "2ND FLOOR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606433135",
"telephone_number": "773-251-8016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARA",
"first_name": "JENNIFER",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-12-12",
"last_updated": "2010-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "180.007386",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.