Provider Demographics
NPI:1295160364
Name:POINDEXTER, JON (LPC)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:
Last Name:POINDEXTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S JEFFERSON ST UNIT 1602
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-3742
Mailing Address - Country:US
Mailing Address - Phone:312-928-0677
Mailing Address - Fax:
Practice Address - Street 1:156 N JEFFERSON ST
Practice Address - Street 2:STE. 201-B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1411
Practice Address - Country:US
Practice Address - Phone:312-622-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008460101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional