Matthew King, BA – Mental Health Counselor

Key facts

NPI: 1114306305
Entity type: Individual (NPI type 1)
Primary specialty: Mental Health Counselor 101YM0800X
Practice address: 204 W Highland Ave
Robinson, IL 62454-1710
Phone: (618) 546-1021
Fax: (618) 544-7892
NPI assigned: May 21, 2015
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Bachelor of Arts

Specialties & licenses

Specialty (taxonomy)	Code	Primary
Counselor	101Y00000X
Addiction (Substance Use Disorder) Counselor	101YA0400X
Mental Health Counselor	101YM0800X	Yes
Professional Counselor	101YP2500X

Addresses

Primary practice location

204 W Highland Ave
Robinson, IL 62454-1710

Mailing address

504 Micah Dr
Drawer M
Olney, IL 62450-4720
Phone (618) 395-4506

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 21, 2015.

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432166400000",
    "number": "1114306305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 MICAH DR",
            "address_2": "DRAWER M",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624504720",
            "telephone_number": "618-395-4506",
            "fax_number": "618-395-4507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W HIGHLAND AVE",
            "city": "ROBINSON",
            "state": "IL",
            "postal_code": "624541710",
            "telephone_number": "618-546-1021",
            "fax_number": "618-544-7892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "BA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-21",
        "last_updated": "2015-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Robinson, IL

All providers in Robinson, IL · Mental Health Counselor in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 21, 2015. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.