NPIMap

Organization Active NPI

Past Present Future

  • Mental Health Counselor
  • Lisle, IL
National Provider Identifier
1952904468
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PAST PRESENT FUTURE
Practice address
4300 Commerce CT Ste 300-9
Lisle, IL 60532-3709
Phone
(630) 791-7117
NPI assigned
Nov 18, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

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

Authorized official

Name
Dr. Donna C Bredrup, DSW, LCPCNPI 1902970833
Title
Owner/Counselor
Phone
(630) 791-7117

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

4300 Commerce CT Ste 300-9
Lisle, IL 60532-3709

Mailing address

4832 Wallbank Ave
Downers Grove, IL 60515-3404
Phone (630) 791-7117

National Provider Directory

National Provider Directory

Locations

4300 Commerce Ct
Ste 3009
Lisle, IL 60532
Phone (248) 790-0943

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1605657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1952904468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4832 WALLBANK AVE",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605153404",
            "telephone_number": "630-791-7117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 COMMERCE CT STE 300-9",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323709",
            "telephone_number": "630-791-7117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAST PRESENT FUTURE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-18",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "BREDRUP",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/COUNSELOR",
        "authorized_official_telephone_number": "630-791-7117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DSW, LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "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 Nov 18, 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.