Individual
JENNIFER LYNN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, CCMHC, LBS1
Contact information
Practice address
1125 CLEVELAND ST, EVANSTON, IL 60202
(224) 830-9800
Mailing address
1125 CLEVELAND ST, EVANSTON, IL 60202-2114
(224) 830-9800
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
IL
101YP2500X
Professional Counselor
Primary
180011432
IL
174400000X
Specialist
—
—
174H00000X
Health Educator
—
—
Other
Enumeration date
12/30/2008
Last updated
05/23/2018
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