NPIMap

Organization Active NPI

Collaborative Counseling Group of Illinois PLLC

  • Clinical Social Worker
  • Mundelein, IL
National Provider Identifier
1730810318
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
COLLABORATIVE COUNSELING GROUP OF ILLINOIS PLLC
Practice address
201 Maplewood Ave
Mundelein, IL 60060-4129
Phone
(847) 807-5622
NPI assigned
Jun 23, 2022
Last updated
Jun 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

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

Authorized official

Name
Mr. Damien Jackson, LCSWNPI 1588256424
Title
Owner
Phone
(224) 766-9993

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

201 Maplewood Ave
Mundelein, IL 60060-4129

Mailing address

1 N Oplaine Rd Unit 114
Gurnee, IL 60031-0804

National Provider Directory

National Provider Directory

Locations

1 N Oplaine Rd
Unit 114
Gurnee, IL 60031

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1655942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655942400000",
    "number": "1730810318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 N OPLAINE RD UNIT 114",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600310804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 MAPLEWOOD AVE",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600604129",
            "telephone_number": "847-807-5622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLABORATIVE COUNSELING GROUP OF ILLINOIS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-23",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "DAMIEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "224-766-9993",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mundelein, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; 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.