Active NPI
Keith Driscoll, P.HD
- Behavior Analyst
- Centralia, IL
National Provider Identifier
1073899621
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 601986842
- Practice address
- 1207 S Elm St
Centralia, IL 62801 - Phone
- (618) 579-9072
- NPI assigned
- Oct 27, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 601986842 | WA | Primary |
Addresses
Primary practice location
1207 S Elm St
Centralia, IL 62801
Mailing address
1207 S Elm St
Centralia, IL 62801-4738
Phone (618) 579-9072
Other practice location 1
904 E. Martin Luther King Drive
Centralia, IL 62801-3058
Phone (618) 533-1391 ext. 132
Other practice location 2
140 N Locust St
Centralia, IL 62801-3243
Phone (618) 579-9072
Other practice location 3
1207 S Elm St
Centralia, IL 62801
Phone (618) 579-9072 ext. 61857
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 601986842 | WA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542758400000",
"number": "1073899621",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1207 S ELM ST",
"city": "CENTRALIA",
"state": "IL",
"postal_code": "628014738",
"telephone_number": "618-579-9072"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1207 S ELM ST",
"city": "CENTRALIA",
"state": "IL",
"postal_code": "62801",
"telephone_number": "618-579-9072"
}
],
"practiceLocations": [
{
"address_1": "904 E. Martin Luther King Drive",
"address_purpose": "LOCATION",
"city": "Centralia",
"state": "IL",
"postal_code": "628013058",
"country_code": "US",
"telephone_number": "618-533-1391 x132",
"fax_number": "618-533-0012",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "140 N Locust St",
"address_purpose": "LOCATION",
"city": "Centralia",
"state": "IL",
"postal_code": "628013243",
"country_code": "US",
"telephone_number": "618-579-9072",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1207 S Elm St",
"address_purpose": "LOCATION",
"city": "Centralia",
"state": "IL",
"postal_code": "62801",
"country_code": "US",
"telephone_number": "618-579-9072 x61857",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DRISCOLL",
"first_name": "KEITH",
"name_prefix": "Mr.",
"credential": "P.HD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-27",
"last_updated": "2018-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "WA",
"license": "601986842",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centralia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.