Active NPI
Jamie Kmieciak
- Mental Health Counselor
- Lisle, IL
National Provider Identifier
1902653199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 178.020146
- Practice address
- 4745 Main St Ste 207
Lisle, IL 60532-1758 - Phone
- (630) 442-1895
- NPI assigned
- May 4, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 178.020146 | IL | Primary |
Addresses
Primary practice location
4745 Main St Ste 207
Lisle, IL 60532-1758
Mailing address
4285 White Birch Dr
Lisle, IL 60532-1252
Phone (630) 244-9682
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.020146 | IL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Your Story Counseling, P.C. | Past | Accepting new patients | |
| Green Root Therapy | Mental Health | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Clinical Social Worker
- Lisle, IL
- NPI 1306248497
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714780800000",
"number": "1902653199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4285 WHITE BIRCH DR",
"city": "LISLE",
"state": "IL",
"postal_code": "605321252",
"telephone_number": "630-244-9682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4745 MAIN ST STE 207",
"city": "LISLE",
"state": "IL",
"postal_code": "605321758",
"telephone_number": "630-442-1895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KMIECIAK",
"first_name": "JAMIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-04",
"last_updated": "2024-05-04",
"certification_date": "2024-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "178.020146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lisle, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.