Active NPI
Crystal Edwards
- Addiction (Substance Use Disorder) Counselor
- Charleston, IL
National Provider Identifier
1205335064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 34419
- Practice address
- 903 W Lincoln Ave
Charleston, IL 61920-2413 - Phone
- (217) 348-8384
- NPI assigned
- Feb 7, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 34419 | IL | Primary |
Addresses
Primary practice location
903 W Lincoln Ave
Charleston, IL 61920-2413
Mailing address
903 W Lincoln Ave
Charleston, IL 61920-2413
Phone (217) 348-8384
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 743113035 | Other | IL | FEIN |
Other names 1
- Crystal Humel
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 |
|---|---|---|---|
| 34419 | IL | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517961600000",
"number": "1205335064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "903 W LINCOLN AVE",
"city": "CHARLESTON",
"state": "IL",
"postal_code": "619202413",
"telephone_number": "217-348-8384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "903 W LINCOLN AVE",
"city": "CHARLESTON",
"state": "IL",
"postal_code": "619202413",
"telephone_number": "217-348-8384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "CRYSTAL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-07",
"last_updated": "2018-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IL",
"license": "34419",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEIN",
"identifier": "743113035",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CRYSTAL",
"last_name": "HUMEL",
"credential": "BS CADC",
"code": "5",
"type": "Other Name"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.