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JISUN PARK B.A.
NPI 1386945459
Counselor - Mental Health in Mattoon, IL

Active since November 05, 2010
750 BROADWAY AVE E, MATTOON, IL 61938(217) 238-5700(217) 238-5767 Get Directions Write a Review

NPPES record last updated: November 5, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jisun Park B.a. NPPES

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

JISUN PARK B.A. (NPI 1386945459) is an individual mental health provider in Mattoon, Illinois and active in the NPI registry since November 2010.

NPPES Registry Identity

NPI1386945459
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameJISUN PARKCredential: B.A.
Location Address750 BROADWAY AVE EMattoon, IL 61938-4610
Mailing Address750 Broadway Ave EMattoon, IL 61938-4610 · (217) 238-5700 · Fax (217) 238-5767
Phone(217) 238-5700
Fax(217) 238-5767
Sole ProprietorNo
Enumeration DateNovember 5, 2010
✔ NPI 1386945459 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
750 BROADWAY AVE E, Mattoon, IL 61938
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Other Names 1

Other Name (5)Kelly Park

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.

KIAYA LOY MS, MHP
Counselor
750 BROADWAY AVE E
MATTOON, IL 61938
Coles County (217) 238-5700
NERISSA JONES BA
Counselor (Mental Health)
750 BROADWAY AVE E
MATTOON, IL 61938
Coles County (217) 238-5735
JESSICA MILBURN LCPC
Counselor (Professional)
750 BROADWAY AVE E
MATTOON, IL 61938
Coles County (217) 238-5700
TAYLOR DOWNEY MS
Counselor (Mental Health)
750 BROADWAY AVE E
MATTOON, IL 61938
Coles County (217) 238-5700
ALLEN M. CREAMEAN B.S.
Counselor (Mental Health)
750 BROADWAY AVE E
MATTOON, IL 61938
Coles County (217) 238-5700
MADELEINE STONE
Counselor (Mental Health)
750 BROADWAY AVE E
MATTOON, IL 61938
Coles County (217) 238-5700
AMY KIRKMAN
Counselor (Mental Health)
750 BROADWAY AVE E
MATTOON, IL 61938
Coles County (217) 238-5700
DANIELLE NEWCOMER
Counselor (Mental Health)
750 BROADWAY AVE E
MATTOON, IL 61938
Coles County (217) 238-5700

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 Jisun Park's NPI number?

The NPI number for Jisun Park is 1386945459. It was assigned to this individual provider in the NPPES registry on November 5, 2010. The provider is also known as Kelly Park.

Where is Jisun Park located?

Jisun Park practices at 750 Broadway Ave E, Mattoon, IL 61938. The listed phone number is (217) 238-5700.

What is Jisun Park's specialty?

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

When was this NPI record last updated?

The NPPES record for Jisun Park was last updated on November 5, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.