Active NPI
Staci Poe
- Professional Counselor
- Champaign, IL
National Provider Identifier
1003234972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.009748
- Practice address
- 44 E Main St
Ste 406
Champaign, IL 61820-3636 - Phone
- (217) 398-9066
- Fax
- (217) 398-9077
- NPI assigned
- Mar 28, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.009748 | IL | Primary |
Addresses
Primary practice location
44 E Main St
Ste 406
Champaign, IL 61820-3636
Mailing address
44 E Main St
Ste 406
Champaign, IL 61820-3636
Phone (217) 398-9066
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 178.009748 | Other | IL | IDFPR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.009748 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395964800000",
"number": "1003234972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44 E MAIN ST",
"address_2": "STE 406",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618203636",
"telephone_number": "217-398-9066",
"fax_number": "217-398-9077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44 E MAIN ST",
"address_2": "STE 406",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618203636",
"telephone_number": "217-398-9066",
"fax_number": "217-398-9077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POE",
"first_name": "STACI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-28",
"last_updated": "2014-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.009748",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDFPR",
"identifier": "178.009748",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.