Active NPI
Patrick J. Carroll, LCSW
- Professional Counselor
- Normal, IL
National Provider Identifier
1346259140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 405 Kays Dr
Normal, IL 61761-1979 - Phone
- (309) 888-9979
- Fax
- (309) 888-9111
- NPI assigned
- Aug 8, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | IL | Primary |
Addresses
Primary practice location
405 Kays Dr
Normal, IL 61761-1979
Mailing address
512 Ironwood CC Dr
Normal, IL 61761-5267
Phone (309) 263-5565
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 |
|---|---|---|---|
| 149-008032 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Agape Counseling, LTD | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1346259140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "512 IRONWOOD CC DR",
"city": "NORMAL",
"state": "IL",
"postal_code": "617615267",
"telephone_number": "309-263-5565",
"fax_number": "309-263-9336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 KAYS DR",
"city": "NORMAL",
"state": "IL",
"postal_code": "617611979",
"telephone_number": "309-888-9979",
"fax_number": "309-888-9111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "PATRICK",
"middle_name": "J.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.