Healthcare Provider Details

I. General information

NPI: 1841698594
Provider Name (Legal Business Name): JENS HUSSEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E WASHINGTON ST STE 1719
CHICAGO IL
60602-1708
US

IV. Provider business mailing address

25 E WASHINGTON ST STE 1719 SUITE R
CHICAGO IL
60602-1708
US

V. Phone/Fax

Practice location:
  • Phone: 708-308-4149
  • Fax:
Mailing address:
  • Phone: 708-308-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.008539
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.007150
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30569 CADC
License Number StateIL

VIII. Authorized Official

Name: JENS HUSSEY
Title or Position: OWNER
Credential: LCPC
Phone: 708-308-4149