=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528336328
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA FOX LEVY LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2011
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36 MAIN STREET SUITE 104
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-545-0500
-----------------------------------------------------
Fax | 888-440-2577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 MAIN STREET, SUITE 104
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-545-0500
-----------------------------------------------------
Fax | 888-440-2577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180.007767
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP1600X
-----------------------------------------------------
Taxonomy Name | Pastoral Counselor
-----------------------------------------------------
License Number | 180.007767
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------