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General NPI Number Information
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NPI Number | 1912849704
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Entity Type | Individual
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Provider Name | JAKE CARMAN
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Gender | Male
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 4481 ASH GROVE DR STE B
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City | SPRINGFIELD
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State | IL
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Zip | 62711-6359
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Country | US
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Telephone | 847-809-2669
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Fax |
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Provider Business Mailing Address
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Address Line | 728 W WOODLAND AVE
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City | SPRINGFIELD
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State | IL
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Zip | 62704-2837
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Country | US
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Telephone | 847-809-2669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | NCC2527016
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License Number State | IL
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