Healthcare Provider Details

I. General information

NPI: 1114713682
Provider Name (Legal Business Name): LOVE BEHAVIORAL HEALTH CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4749 LINCOLN MALL DR STE 202H PMB2010
MATTESON IL
60443
US

IV. Provider business mailing address

PO BOX 223
PARK FOREST IL
60466-0223
US

V. Phone/Fax

Practice location:
  • Phone: 312-561-6215
  • Fax:
Mailing address:
  • Phone: 312-561-6215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA LOVE JORDAN
Title or Position: OWNER/OPERATOR
Credential: PHD, LCPC, CADC
Phone: 312-561-6215