Ethan Smith, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

178016281 Issued in IL

Practice address

535 Elm PL Ste 7
Princeton, IL 61356-1458

Phone

(815) 872-2943

Fax

(815) 915-8756

NPI assigned

May 19, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arukah Institute of Healing Inc NFP

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Princeton, IL
  • NPI 1790352482
  NPD
• Arukah Institute of Healing Inc NFP

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Princeton, IL
  • NPI 1740859008
  NPD (past)

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

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1043884497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 ELM PL STE 7",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613561458",
            "telephone_number": "815-872-2943",
            "fax_number": "815-915-8756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 ELM PL STE 7",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613561458",
            "telephone_number": "815-872-2943",
            "fax_number": "815-915-8756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ETHAN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-19",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178016281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Setco Inc
• Bruce Waldo Shriver, DDS
• Kimberly Anne Shuler, R.D.
• Joseph D. Siegel, LCSW
• Agnes M Smith, ST
• Jenna Sobin
• Madison Solomon, PT, DPT
• St Margaret'S Hospital
• St. Margaret'S Health - Spring Valley
• Jennifer K Stickel, P.T.

• Professional Counselor in Princeton, IL
• Providers in Princeton, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; 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.