Active NPI
Tracee Durham
- Counselor
- Decatur, IL
National Provider Identifier
1306426002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 150-104984
- Practice address
- 151 N Main St
Decatur, IL 62523-1206 - Phone
- (217) 420-4776
- Fax
- (217) 362-9007
- NPI assigned
- Apr 8, 2021
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 150-104984 | IL | Primary |
Addresses
Primary practice location
151 N Main St
Decatur, IL 62523-1206
Mailing address
151 N Main St
Decatur, IL 62523-1206
Phone (217) 420-4776
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 |
|---|---|---|---|
| 150-104984 | IL | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617840000000",
"number": "1306426002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 N MAIN ST",
"city": "DECATUR",
"state": "IL",
"postal_code": "625231206",
"telephone_number": "217-420-4776",
"fax_number": "217-362-9007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 N MAIN ST",
"city": "DECATUR",
"state": "IL",
"postal_code": "625231206",
"telephone_number": "217-420-4776",
"fax_number": "217-362-9007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DURHAM",
"first_name": "TRACEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-08",
"last_updated": "2021-04-08",
"certification_date": "2021-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IL",
"license": "150-104984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.