Donna Marie Oldenburg, LCPC, NCC, CCMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

178.013241 Issued in IL

Practice address

900 North Shore Dr Ste 200
Lake Bluff, IL 60044-2225

Phone

(847) 238-2458

Fax

(847) 234-1191

NPI assigned

Sep 25, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Gurnee Counseling Center

  • Mental Health Counselor
  • Gurnee, IL
  • NPI 1871624619
  NPD (past)

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

{
    "created_epoch": "1506297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582761600000",
    "number": "1972012672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 NORTH SHORE DR STE 200",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "600442225",
            "telephone_number": "847-238-2458",
            "fax_number": "847-234-1191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 NORTH SHORE DR STE 200",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "600442225",
            "telephone_number": "847-238-2458",
            "fax_number": "847-234-1191"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4212 Old Grand Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Gurnee",
            "state": "IL",
            "postal_code": "600312708",
            "country_code": "US",
            "telephone_number": "847-336-5621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLDENBURG",
        "first_name": "DONNA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LCPC, NCC, CCMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-25",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180012402",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.013241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Lake Bluff, IL
• Providers in Lake Bluff, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.