Deborah Lubertha Jellema, L.C.P.C., L.M.H.C.

Primary specialty

CounselorTaxonomy code 101Y00000X

License

180005849 Issued in IL

Practice address

2325 177TH St
Lansing, IL 60438-1722

Phone

(708) 895-7310

Fax

(708) 895-7602

NPI assigned

Aug 4, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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 and National Provider Directory roles.

• New Leaf Resources

  • Mental Health Counselor
  • Lansing, IL
  • NPI 1508824830
  NPD (past)

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

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217808000000",
    "number": "1740446293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 177TH ST",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604381722",
            "telephone_number": "708-895-7310",
            "fax_number": "708-895-7602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 177TH ST",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604381722",
            "telephone_number": "708-895-7310",
            "fax_number": "708-895-7602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JELLEMA",
        "first_name": "DEBORAH",
        "middle_name": "LUBERTHA",
        "name_prefix": "Ms.",
        "credential": "L.C.P.C., L.M.H.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-04",
        "last_updated": "2008-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "180005849",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IN",
            "license": "39001865A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Counselor in Lansing, IL
• Providers in Lansing, IL by specialty
• Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; 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.