Active NPI
Ciara Rose Nichols, LPC, NCC
- Mental Health Counselor
- Homer Glen, IL
National Provider Identifier
1750150702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 178.019322
- Practice address
- 14933 Founders Xing
Homer Glen, IL 60491-6712 - Phone
- (708) 737-7968
- NPI assigned
- Jan 1, 2024
- Last updated
- Jan 1, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 178.019322 | IL | Primary |
Addresses
Primary practice location
14933 Founders Xing
Homer Glen, IL 60491-6712
Mailing address
11704 Brookwood Dr
Orland Park, IL 60467-6089
Phone (708) 921-7803
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.019322 | IL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beyond Healing | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704067200000",
"number": "1750150702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11704 BROOKWOOD DR",
"city": "ORLAND PARK",
"state": "IL",
"postal_code": "604676089",
"telephone_number": "708-921-7803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14933 FOUNDERS XING",
"city": "HOMER GLEN",
"state": "IL",
"postal_code": "604916712",
"telephone_number": "708-737-7968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "CIARA",
"middle_name": "ROSE",
"credential": "LPC, NCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-01",
"last_updated": "2024-01-01",
"certification_date": "2023-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "178.019322",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Homer Glen, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.