Providence Counseling Associates, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

PROVIDENCE COUNSELING ASSOCIATES, LLC

Practice address

445 W Jackson Ave Ste 206
Naperville, IL 60540-5258

Phone

(630) 420-2596

Fax

(630) 420-2796

NPI assigned

Mar 7, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Stephanie Joy Spackey, PSY.D.

Title

Managing Member

Phone

(630) 420-2596

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236643200000",
    "number": "1861523680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 W JACKSON AVE STE 206",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605405258",
            "telephone_number": "630-420-2596",
            "fax_number": "630-420-2796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 W JACKSON AVE STE 206",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605405258",
            "telephone_number": "630-420-2596",
            "fax_number": "630-420-2796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE COUNSELING ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2009-03-10",
        "status": "A",
        "authorized_official_last_name": "SPACKEY",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "JOY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "630-420-2596",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "0032240364",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2009; 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.