India Blakely, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180007413 Issued in IL

Practice address

17337 Wooded Path Dr Apt 3S
East Hazel Crest, IL 60429-2619

Phone

(708) 805-9380

NPI assigned

Sep 27, 2020

Last updated

Sep 27, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Specialty

Mental Health Counselor

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Zoe Community Counseling LLC

  • Community/Behavioral Health Agency
  • Glenwood, IL
  • NPI 1285382788
  NPD Authorized official

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

{
    "created_epoch": "1601164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601164800000",
    "number": "1710594445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18300 S. HALSTED",
            "address_2": "SUITE B MAILBOX 107",
            "city": "GLENWOOD",
            "state": "IL",
            "postal_code": "60425",
            "telephone_number": "312-736-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17337 WOODED PATH DR APT 3S",
            "city": "EAST HAZEL CREST",
            "state": "IL",
            "postal_code": "604292619",
            "telephone_number": "708-805-9380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKELY",
        "first_name": "INDIA",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-27",
        "last_updated": "2020-09-27",
        "certification_date": "2020-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180007413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Berymon
• Asia Bey
• Amanda Biddle
• Aireiun Binion
• Terri Bjarnson, CAADC
• Pamela Blalock
• Tanya Blue-Duplessis
• Betty Bowen
• Breath of Life Asthma Clinic
• Lisa Bridges, BA

• Mental Health Counselor in East Hazel Crest, IL
• Providers in East Hazel Crest, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.