Jeremiah Bergen, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180.007358 Issued in IL

Practice address

4525 N Ravenswood Ave Ste 202
Chicago, IL 60640-8038

Phone

(312) 870-0500

NPI assigned

Dec 29, 2009

Sex

Male

Sole proprietor

No

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

Locations

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.

• Bergen Psychological Services, Inc.

  • Mental Health Counselor
  • Chicago, IL
  • NPI 1174819874
  NPD Authorized official

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

{
    "created_epoch": "1262044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781136000000",
    "number": "1750611596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4525 N RAVENSWOOD AVE STE 202",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606408038",
            "telephone_number": "312-870-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4525 N RAVENSWOOD AVE STE 202",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606408038",
            "telephone_number": "312-870-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGEN",
        "first_name": "JEREMIAH",
        "name_prefix": "Mr.",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-29",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180007358",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.007358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bergen Psychological Services, Inc.
• Anne Bergen
• Carrie Bergen
• Donna C Bergen, MD
• Jennifer Gorman Bergen, FNP-BC, APRN
• Joseph T Bergen, PT, DPT
• Rachel Elizabeth Bergen, DPT
• Rebecca June-Schapeler Bergen, PH.D.
• Berger and Burrow Enterprises Inc.
• Berger Park Cultural Center

• Mental Health Counselor in Chicago, IL
• Providers in Chicago, 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 Jun 11, 2026; 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.