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NICHOLE JETERS LCPC
NPI 1174770648
Counselor - Mental Health in Carbondale, IL

Active since August 26, 2008PECOS EnrolledAccepts Medicare Assignment
405 W JACKSON ST, CARBONDALE, IL 62901(618) 549-0721(618) 457-0469 Get Directions Write a Review

NPPES record last updated: March 6, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 6, 2026, Jan 16, 2026, Jun 7, 2019 and 1 more (4 updates tracked since 2015).

About Nichole Jeters Lcpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICHOLE JETERS LCPC (NPI 1174770648) is an individual mental health provider in Carbondale, Illinois, licensed in Illinois (180009521) and active in the NPI registry since August 2008. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2012).

NPPES Registry Identity

NPI1174770648
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameNICHOLE JETERSCredential: LCPC
Location Address405 W JACKSON STCarbondale, IL 62901-1462
Mailing AddressPo Box 3988Carbondale, IL 62902-3988 · (618) 457-5200
Phone(618) 549-0721
Fax(618) 457-0469
Sole ProprietorNo
Medical School CMSOtherGraduated 2012
Enumeration DateAugust 26, 2008
Last NPPES UpdateMarch 6, 20264 updates tracked since enumeration
NPPES CertifiedMarch 6, 2026
✔ NPI 1174770648 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in IL · 180009521
Also ListedCounselor · ProfessionalTaxonomy 101YP2500X · License 180009521 (IL)
405 W JACKSON ST, Carbondale, IL 62901
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Other Names 1

Former Name (1)Nichole King Lcpc

Secondary Practice Locations 2

Location 1201 S 14th StHerrin, IL 62948-3631 · Phone (618) 942-2171 · Fax (618) 351-4917
Location 22 S Hospital DrMurphysboro, IL 62966-3333 · Phone (618) 684-3156 · Fax (618) 529-0524

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nichole Jeters Lcpc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8426535295
PECOS Enrollment IDI20260122003465
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. LUKAS WARD PA
Physician Assistant
405 W JACKSON ST
CARBONDALE, IL 62901
Jackson County (618) 549-0721
RUPAL PARMAR M.D.
Pathology (Anatomic Pathology & Clinical Pathology)
405 W JACKSON ST
CARBONDALE, IL 62901
Jackson County (618) 549-0721
SCOTT A. COOPER M.D.
Emergency Medicine
405 W JACKSON ST, MEMORIAL HOSPITAL
CARBONDALE, IL 62901
Jackson County (618) 549-0721
LONG HA HUYNH M.D., PH.D.
Anesthesiology
405 W JACKSON ST
CARBONDALE, IL 62901
Jackson County (618) 549-0721
MS. BRITNEY NICOLE ARNOLD PA-C
Physician Assistant
405 W JACKSON ST
CARBONDALE, IL 62901
Jackson County (618) 549-0721
MR. DAN EDWARD MILLER CRNA
Nurse Anesthetist, Certified Registered
405 W JACKSON ST
CARBONDALE, IL 62901
Jackson County (618) 549-0721
AMANDA M RYDEN MD
Emergency Medicine
405 W JACKSON ST
CARBONDALE, IL 62901
Jackson County (618) 549-0721
MS. NICOLE A JOHNSON PA-C
Physician Assistant
405 W JACKSON ST
CARBONDALE, IL 62901
Jackson County (618) 549-0721

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nichole Jeters's NPI number?

The NPI number for Nichole Jeters is 1174770648. It was assigned to this individual provider in the NPPES registry on August 26, 2008. The provider is also known as Nichole King Lcpc.

Where is Nichole Jeters located?

Nichole Jeters practices at 405 W Jackson St, Carbondale, IL 62901. The listed phone number is (618) 549-0721.

What is Nichole Jeters's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Nichole Jeters enrolled in Medicare?

Yes. Nichole Jeters is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Nichole Jeters was last updated on March 6, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.