Active NPI
Mark Wichman
- Mental Health Counselor
- Pontiac, IL
National Provider Identifier
1285785998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 180-005327
- Practice address
- 417 W Water St
Pontiac, IL 61764-1750 - Phone
- (815) 867-7509
- NPI assigned
- Jan 16, 2007
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 180-005327 | IL | Primary |
Addresses
Primary practice location
417 W Water St
Pontiac, IL 61764-1750
Mailing address
PO Box 351
Pontiac, IL 61764-0351
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 |
|---|---|---|---|
| 180-005327 | IL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335225600000",
"number": "1285785998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 351",
"city": "PONTIAC",
"state": "IL",
"postal_code": "617640351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "417 W WATER ST",
"city": "PONTIAC",
"state": "IL",
"postal_code": "617641750",
"telephone_number": "815-867-7509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICHMAN",
"first_name": "MARK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2012-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "180-005327",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.