Basic Information
| Provider Information | |||||||||
| NPI: | 1639538853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOKER | ||||||||
| FirstName: | JEREMY | ||||||||
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| Credential: | MSED, LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100 | ||||||||
| Address2: | |||||||||
| City: | NACHUSA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610570100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152847796 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1261 IL-38 | ||||||||
| Address2: | |||||||||
| City: | NACHUSA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152847796 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2016 | ||||||||
| LastUpdateDate: | 02/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180.005647 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.