Healthcare Provider Details

I. General information

NPI: 1841115680
Provider Name (Legal Business Name): JACLYNN MCCARVILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 RENAISSANCE DR STE 420
PARK RIDGE IL
60068-1356
US

IV. Provider business mailing address

1516 N KEYSTONE AVE APT 3
CHICAGO IL
60651-3490
US

V. Phone/Fax

Practice location:
  • Phone: 773-280-7405
  • Fax:
Mailing address:
  • Phone: 929-519-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: