Active NPI
Marc Edward Mitchell, LPC
- Professional Counselor
- Plainfield, IL
National Provider Identifier
1154952539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.015097
- Practice address
- 13430 Skyline Dr
Plainfield, IL 60585-1914 - Phone
- (630) 650-6272
- NPI assigned
- Feb 4, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.015097 | IL | Primary |
Addresses
Primary practice location
13430 Skyline Dr
Plainfield, IL 60585-1914
Mailing address
13430 Skyline Dr
Plainfield, IL 60585-1914
Phone (630) 650-6272
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mmitchell@momentumphysicaltherapy.com |
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 |
|---|---|---|---|
| 178.015097 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brady, P.C. | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580774400000",
"number": "1154952539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13430 SKYLINE DR",
"city": "PLAINFIELD",
"state": "IL",
"postal_code": "605851914",
"telephone_number": "630-650-6272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13430 SKYLINE DR",
"city": "PLAINFIELD",
"state": "IL",
"postal_code": "605851914",
"telephone_number": "630-650-6272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "MARC",
"middle_name": "EDWARD",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-02-04",
"last_updated": "2020-02-04",
"certification_date": "2020-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.015097",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mmitchell@momentumphysicaltherapy.com",
"affiliation": "N",
"address_1": "13430 Skyline Dr",
"city": "Plainfield",
"state": "IL",
"country_code": "US",
"postal_code": "605851914",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Plainfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.