NPIMap

Organization Active NPI

Sanctuary Community Counseling and Resources, NFP

  • Clinical Psychologist
  • Calumet Park, IL
National Provider Identifier
1790310159
Registry record updated Mar 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SANCTUARY COMMUNITY COUNSELING AND RESOURCES, NFP
Practice address
12247 S Racine Ave
Calumet Park, IL 60643-5401
Phone
(312) 687-0198
NPI assigned
Mar 5, 2020
Last updated
Mar 5, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SANCTUARY COUNSELING, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2020

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

Authorized official

Name
Dr. Roy C Reese Jr.NPI 1447885801
Title
President Cfo
Phone
(773) 717-9921

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Clinical Psychologist 103TC0700X NU Primary
Community/Behavioral Health Agency 251S00000X NU
Religious Nonmedical Health Care Institution 282J00000X NU

Addresses

Primary practice location

12247 S Racine Ave
Calumet Park, IL 60643-5401

Mailing address

12247 S Racine Ave
Calumet Park, IL 60643-5401
Phone (312) 687-0198

National Provider Directory

National Provider Directory
Part of
Sanctuary Counseling LLC

Practitioners & affiliated clinicians

Practitioners 2

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": "1583366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583366400000",
    "number": "1790310159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12247 S RACINE AVE",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "606435401",
            "telephone_number": "312-687-0198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12247 S RACINE AVE",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "606435401",
            "telephone_number": "312-687-0198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANCTUARY COMMUNITY COUNSELING AND RESOURCES, NFP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANCTUARY COUNSELING, LLC",
        "enumeration_date": "2020-03-05",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A",
        "authorized_official_last_name": "REESE",
        "authorized_official_first_name": "ROY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT CFO",
        "authorized_official_telephone_number": "773-717-9921",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282J00000X",
            "taxonomy_group": "",
            "desc": "Religious Nonmedical Health Care Institution",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Calumet Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; 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.