Active NPI
Victoria Tullock, MSW
- Mental Health Counselor
- Dekalb, IL
National Provider Identifier
1003346628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 631 South First St.
Dekalb, IL 60115 - Phone
- (815) 756-8501
- NPI assigned
- Jun 15, 2017
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
631 South First St.
Dekalb, IL 60115
Mailing address
631 S 1St St
Dekalb, IL 60115-4117
Phone (815) 756-8501
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 474579189001 | Medicaid | IL |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1003346628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "631 S 1ST ST",
"city": "DEKALB",
"state": "IL",
"postal_code": "601154117",
"telephone_number": "815-756-8501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "631 SOUTH FIRST ST.",
"city": "DEKALB",
"state": "IL",
"postal_code": "60115",
"telephone_number": "815-756-8501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TULLOCK",
"first_name": "VICTORIA",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-15",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "474579189001",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.