Active NPI
Elizabeth Thielen
- Professional Counselor
- Round Lake, IL
National Provider Identifier
1932596871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178003548
- Practice address
- 31979 N Fish Lake Rd
Round Lake, IL 60073-9517 - Phone
- (847) 546-6450
- NPI assigned
- Apr 17, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178003548 | IL | Primary |
Addresses
Primary practice location
31979 N Fish Lake Rd
Round Lake, IL 60073-9517
Mailing address
31979 N Fish Lake Rd
Round Lake, IL 60073-9517
Phone (847) 546-6450
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 |
|---|---|---|---|
| 178003548 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429228800000",
"number": "1932596871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31979 N FISH LAKE RD",
"city": "ROUND LAKE",
"state": "IL",
"postal_code": "600739517",
"telephone_number": "847-546-6450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31979 N FISH LAKE RD",
"city": "ROUND LAKE",
"state": "IL",
"postal_code": "600739517",
"telephone_number": "847-546-6450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIELEN",
"first_name": "ELIZABETH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-17",
"last_updated": "2015-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178003548",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Round Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.