William Douglas Portis, LCPC CADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180012458 Issued in IL

Practice address

808 S Eldorado Rd Ste 100C
Bloomington, IL 61704-6075

Phone

(309) 889-6222

NPI assigned

Feb 19, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1003316720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PLANTATION CT",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617049467",
            "telephone_number": "309-889-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 S ELDORADO RD STE 100C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046075",
            "telephone_number": "309-889-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTIS",
        "first_name": "WILLIAM",
        "middle_name": "DOUGLAS",
        "credential": "LCPC CADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-02-19",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "33398",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.009416",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180012458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edward Lee Ponce, PT
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• Jessica Elaine Poppe, CD(DONA)
• Aaron Poppy
• Brynna A Porch
• Matthew William Porzel, LCPC
• Jeffrey Scott Poulter, M.D.
• April Liane Powell
• Leann Michelle (Croft) Powell, PT, MSPT
• Prairie Counseling Services

• Mental Health Counselor in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.