Active NPI
Karen Sullivan
- Professional Counselor
- Crystal Lake, IL
National Provider Identifier
1073938734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.007150
- Practice address
- 111 S Virginia St Ste L03
Crystal Lake, IL 60014-5853 - Phone
- (815) 715-2813
- NPI assigned
- Mar 4, 2014
- Last updated
- Mar 4, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.007150 | IL | Primary |
Addresses
Primary practice location
111 S Virginia St Ste L03
Crystal Lake, IL 60014-5853
Mailing address
36 S Walkup Ave
Crystal Lake, IL 60014-6130
Phone (815) 715-2813
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 |
|---|---|---|---|
| 180.007150 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393891200000",
"number": "1073938734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 S WALKUP AVE",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600146130",
"telephone_number": "815-715-2813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 S VIRGINIA ST STE L03",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600145853",
"telephone_number": "815-715-2813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "KAREN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-03-04",
"last_updated": "2014-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.007150",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.