Susan Elaine Minyard, PH D

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

1701 South Prospect Avenue
Suite 8
Champaign, IL 61820-7050

Phone

(217) 355-9030

Fax

(217) 355-9066

NPI assigned

Aug 29, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 12, 2011 through May 12, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275642969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 SOUTH PROSPECT AVENUE",
            "address_2": "SUITE 8",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618207050",
            "telephone_number": "217-355-9030",
            "fax_number": "217-355-9066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 SOUTH PROSPECT AVENUE",
            "address_2": "SUITE 8",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618207050",
            "telephone_number": "217-355-9030",
            "fax_number": "217-355-9066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINYARD",
        "first_name": "SUSAN",
        "middle_name": "ELAINE",
        "name_prefix": "Dr.",
        "credential": "PH D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20040161",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tytrick Miller
• Timothy A Millikan, PT
• Ashley Lynn Mills
• Mindful Aspirations Counseling and Consulting, LLC.
• Mindworks Mental Health
• Holly N Mirell, PHD
• Philip Norman Mirell, MSW
• Luis Pedro Miron Carcamo
• Sabrina Mirza
• Christina Jean Mitchaner, COTA/L

• Psychologist in Champaign, IL
• Providers in Champaign, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.