Healthcare Provider Details

I. General information

NPI: 1295623627
Provider Name (Legal Business Name): SIMONE JONES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 W 114TH PL
CHICAGO IL
60643-4349
US

IV. Provider business mailing address

1521 W 114TH PL
CHICAGO IL
60643-4349
US

V. Phone/Fax

Practice location:
  • Phone: 708-543-8135
  • Fax:
Mailing address:
  • Phone: 708-543-8135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178021685
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: