Healthcare Provider Details

I. General information

NPI: 1043180649
Provider Name (Legal Business Name): DANA JAY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 S SCHOOLHOUSE RD
NEW LENOX IL
60451-2746
US

IV. Provider business mailing address

9025 ORLAND CT APT 305
ORLAND PARK IL
60462-3395
US

V. Phone/Fax

Practice location:
  • Phone: 708-480-2016
  • Fax:
Mailing address:
  • Phone: 708-710-8374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.017798
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: