NPIMap

Organization Active NPI

Renew You Counseling Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
National Provider Identifier
1750807749
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
071.009553 Issued in IL
Legal business name
RENEW YOU COUNSELING CENTER LLC
Practice address
1209 W Diversey Pwky Unit G-2
Chicago, IL 60614-1201
Phone
(773) 236-8566
Fax
(773) 257-7553
NPI assigned
Aug 21, 2017
Last updated
Jul 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Authorized official

Name
Dr. Jacob Rosser, PSYDNPI 1164724019
Title
Managing Member
Phone
(773) 236-8566

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 071.009553 IL Primary

Addresses

Primary practice location

1209 W Diversey Pwky Unit G-2
Chicago, IL 60614-1201

Mailing address

1209 W Diversey Pkwy Unit G-2
Chicago, IL 60614-1201
Phone (773) 236-8566

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241111000722 IL Part B Supplier - Clinic/Group Practice 9830623081 Receives reassigned benefits from 1 practitioner
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

1209 W Diversey Pkwy
Unit G2
Chicago, IL 60614
Phone (773) 236-8566

3257 N Sheffield Ave
Ste 118
Chicago, IL 60657
Phone (309) 868-3654

Practitioners & affiliated clinicians

Practitioners 12

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": "1503273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1750807749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 W DIVERSEY PKWY UNIT G-2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141201",
            "telephone_number": "773-236-8566",
            "fax_number": "773-257-7553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 W DIVERSEY PWKY UNIT G-2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141201",
            "telephone_number": "773-236-8566",
            "fax_number": "773-257-7553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW YOU COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-21",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "ROSSER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "773-236-8566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IL",
            "license": "071.009553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.