Samantha Marie Vazquez, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180.011006 Issued in IL

Practice address

10104 S Utica Ave
Evergreen Park, IL 60805-3527

Phone

(304) 280-6360

NPI assigned

Jul 11, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Samantha Marie McGlumphy Former name

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.

• Evergrace Therapy LLC

  • Adult Mental Health Clinic/Center
  • Evergreen Park, IL
  • NPI 1164292645
  NPD Authorized official

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

{
    "created_epoch": "1499731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1790207868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10104 S UTICA AVE",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608053527",
            "telephone_number": "304-280-6360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10104 S UTICA AVE",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608053527",
            "telephone_number": "304-280-6360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAZQUEZ",
        "first_name": "SAMANTHA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-11",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.011006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "MCGLUMPHY",
            "middle_name": "MARIE",
            "credential": "LCPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Uropartners, LLC
• Valentin Berman MD PC
• Valentine Home Health Care Inc
• Ourania Vassiliou, RPH
• Melissa A Vazquez, PHARMD
• Kunjumol Pullathra Velayudhan, ANP
• Anna Maria Velazquez, RDN
• Rachel Vetter, FNP
• Arnulfo Vielgo, M.D.
• Village of Evergreen Park

• Mental Health Counselor in Evergreen Park, IL
• Providers in Evergreen Park, 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 Dec 19, 2023; 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.