Active NPI
Carlton Martin, LPC
- Professional Counselor
- Rockford, IL
National Provider Identifier
1184072126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.011962
- Practice address
- 5896 Creekside LN
Rockford, IL 61114-6466 - Phone
- (815) 670-5791
- NPI assigned
- Jun 1, 2016
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.011962 | IL | Primary |
Addresses
Primary practice location
5896 Creekside LN
Rockford, IL 61114-6466
Mailing address
5896 Creekside LN
Rockford, IL 61114-6466
Phone (815) 670-5791
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 |
|---|---|---|---|
| 178.011962 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Renita Shores-Gaston | 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.
-
- Clinical Social Worker
- Rockford, IL
- NPI 1518421577
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464739200000",
"number": "1184072126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5896 CREEKSIDE LN",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611146466",
"telephone_number": "815-670-5791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5896 CREEKSIDE LN",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611146466",
"telephone_number": "815-670-5791"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "CARLTON",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-01",
"last_updated": "2016-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.011962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.