Blue Island Counseling LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

BLUE ISLAND COUNSELING LLC

Practice address

2343 Canal St
Blue Island, IL 60406-2956

Phone

(708) 674-8735

NPI assigned

Dec 16, 2019

Last updated

Dec 16, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Justin Christopher Kozak, LCPCNPI 1972054294

Title

Ceo

Phone

(708) 829-5673

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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.

• Justin Kozak

  • Professional Counselor
  • Chicago, IL
  • NPI 1972054294
  Authorized official Same address or phone

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

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576454400000",
    "number": "1740828284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2343 CANAL ST",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062956",
            "telephone_number": "708-674-8735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2343 CANAL ST",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062956",
            "telephone_number": "708-674-8735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE ISLAND COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-16",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A",
        "authorized_official_last_name": "KOZAK",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-829-5673",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972054294",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christine Pabin Bishof, MD
• Victoria Blackmon, OCCUPATION THERAPY
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• Blue Island Clinic Company LLC
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• Blue Island Home Care Services LLC (MetroSouth Hospice)
• Blue Island Hospital Company LLC (Metrosouth Medical Center)
• Blue Island Hospital Company LLC (Metro South Medical Center)
• Blue Island Medical Center Pharmacy Inc

• Community/Behavioral Health Agency in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2019; 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.