Active NPI
Jill Renee Van Dyke, LPC-A
- Mental Health Counselor
- Prosper, TX
National Provider Identifier
1962173005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 84925
- Practice address
- 161 W 3Rd St Ste 100
Prosper, TX 75078-2906 - Phone
- (214) 618-8402
- NPI assigned
- Sep 27, 2021
- Last updated
- Sep 27, 2021
- 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 | 84925 | TX | Primary |
Addresses
Primary practice location
161 W 3Rd St Ste 100
Prosper, TX 75078-2906
Mailing address
2724 War Admiral St
Celina, TX 75009-1722
Phone (708) 917-2401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 14, 2024 through Feb 14, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 84925 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632700800000",
"number": "1962173005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2724 WAR ADMIRAL ST",
"city": "CELINA",
"state": "TX",
"postal_code": "750091722",
"telephone_number": "708-917-2401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "161 W 3RD ST STE 100",
"city": "PROSPER",
"state": "TX",
"postal_code": "750782906",
"telephone_number": "214-618-8402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN DYKE",
"first_name": "JILL",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"credential": "LPC-A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-27",
"last_updated": "2021-09-27",
"certification_date": "2021-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "84925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prosper, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.