Provider Demographics
NPI:1104275676
Name:ATKINS, JELMIR (LPC)
Entity type:Individual
Prefix:
First Name:JELMIR
Middle Name:
Last Name:ATKINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-1850
Mailing Address - Country:US
Mailing Address - Phone:815-762-2327
Mailing Address - Fax:
Practice Address - Street 1:215 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1850
Practice Address - Country:US
Practice Address - Phone:815-762-2327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.008985101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional