NPIMap

Organization Active NPI

One Direction Forward Inc.

  • Adult Mental Health Clinic/Center
  • Matteson, IL
National Provider Identifier
1982340220
Registry record updated May 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
ONE DIRECTION FORWARD INC.
Doing business as
One Direction Forward Inc
Practice address
4747 Lincoln Mall Dr Ste 412
Matteson, IL 60443-3821
Phone
(708) 300-6977
Fax
(708) 300-6978
NPI assigned
May 10, 2022
Last updated
May 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2022

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

Authorized official

Name
Mr. Kenneth Simpson Sr., LCSWNPI 1477089290
Title
Ceo
Phone
(708) 300-6977

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU

Addresses

Primary practice location

4747 Lincoln Mall Dr Ste 412
Matteson, IL 60443-3821

Mailing address

4747 Lincoln Mall Dr Ste 412
Matteson, IL 60443-3821
Phone (708) 300-6977

Other identifiers 1

IdentifierTypeStateIssuer
1215392931MedicaidIL

Other names 1

  • One Direction Forward Inc Doing business as

National Provider Directory

National Provider Directory
Tax ID family
One Direction Forward Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4747 Lincoln Mall Dr
Ste 412
Matteson, IL 60443
Phone (708) 300-6977

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1652140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652140800000",
    "number": "1982340220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4747 LINCOLN MALL DR STE 412",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604433821",
            "telephone_number": "708-300-6977",
            "fax_number": "708-300-6978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 LINCOLN MALL DR STE 412",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604433821",
            "telephone_number": "708-300-6977",
            "fax_number": "708-300-6978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONE DIRECTION FORWARD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-10",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A",
        "authorized_official_last_name": "SIMPSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-300-6977",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215392931",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "One Direction Forward Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Matteson, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; 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.