Ellamonique Baccus

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180007887 Issued in IL

Practice address

16107 Lasalle Street
South Holland, IL 60473

Phone

(800) 361-6880

Fax

(708) 845-5505

NPI assigned

Feb 21, 2013

Last updated

Feb 21, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Chicago Christian Counseling Center Inc

  • Clinical Social Worker
  • Orland Park, IL
  • NPI 1083664510

  Professional

  NPD (past)

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

{
    "created_epoch": "1361404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361404800000",
    "number": "1710227145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15127 S 73RD AVE",
            "address_2": "SUITE G",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624398",
            "telephone_number": "800-361-6880",
            "fax_number": "708-845-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16107 LASALLE STREET",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "60473",
            "telephone_number": "800-361-6880",
            "fax_number": "708-845-5505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACCUS",
        "first_name": "ELLAMONIQUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-21",
        "last_updated": "2013-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180007887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Girma Balcha Assefa, M.D.
• Aunt Martha's Health and Wellness, Inc. (Aunt Martha's South Holland Community Health Center)
• Aunt Martha's Youth Service Center Inc
• Awesome Star Enterprise Inc
• B.O.O.C. Inc.
• Sameera Baig, MD
• Candyce Banks, OTR
• Susan Barclay, MD
• Kimberly Barr
• Chirayu Baxi, MD

• Professional Counselor in South Holland, IL
• Providers in South Holland, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2013; 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.