Preston Eugene Berry, IADC & CRADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

21R028 Issued in IA

Practice address

1523 S. Fairmont Street
Davenport, IA 52802-5351

Phone

(563) 322-2667

Fax

(563) 322-3671

NPI assigned

Sep 17, 2008

Last updated

May 13, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 4

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652400000000",
    "number": "1184873804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1523 S. FAIRMONT STREET",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528025351",
            "telephone_number": "563-322-2667",
            "fax_number": "563-322-3671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1523 S. FAIRMONT STREET",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528025351",
            "telephone_number": "563-322-2667",
            "fax_number": "563-322-3671"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7585 Ingram Road #1501",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "78251",
            "country_code": "US",
            "telephone_number": "210-854-6801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2701 17th St",
            "address_purpose": "LOCATION",
            "city": "Rock Island",
            "state": "IL",
            "postal_code": "612015351",
            "country_code": "US",
            "telephone_number": "093-779-2031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3407 W Columbia Ave",
            "address_purpose": "LOCATION",
            "city": "Davenport",
            "state": "IA",
            "postal_code": "528041313",
            "country_code": "US",
            "telephone_number": "210-993-6432",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "150 Rustleaf Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782421215",
            "country_code": "US",
            "telephone_number": "210-854-6801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERRY",
        "first_name": "PRESTON",
        "middle_name": "EUGENE",
        "credential": "IADC & CRADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-17",
        "last_updated": "2022-05-13",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "7544",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "11618-1121",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "37377",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IA",
            "license": "21R028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ICADC",
            "identifier": "11618-1121",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS DEPARTMENT OF STATE HEALTH SERVICES",
            "identifier": "7544",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IADC",
            "identifier": "21R028",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRADC",
            "identifier": "37377",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "preston.berry59@outlook.com",
            "affiliation": "N",
            "endpointDescription": "preston.berry59@outlook.com",
            "address_1": "3407 W Columbia Ave",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "528041313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kirstin Ann Berger, DPT
• Joseph Edward Bergstrom Sr., DO
• Andrew E Berkow, M.D.
• Adam D Berneking, MD
• David Nils Bernstrom II, LMSW
• Joseph Michael Bertroche, D.O.,J.D.
• Jacklyn Marie Besch, ARNP-FNP
• Katherine Vandenburgh Besser, RDN LDN
• Best Home Care
• Best Home Health Care

• Addiction (Substance Use Disorder) Counselor in Davenport, IA
• Providers in Davenport, IA by specialty
• Addiction (Substance Use Disorder) Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.