Park Place Center

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.003173 Issued in IL

Legal business name

PARK PLACE CENTER

Practice address

201 E Morgan St
Jacksonville, IL 62650-2508

Phone

(217) 245-1655

Fax

(217) 245-4742

NPI assigned

May 25, 2007

Last updated

Oct 5, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Ed J Scott, L.C.S.W.NPI 1972851905

Title

Director

Phone

(217) 245-1655

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ed Jay Scott, L.C.S.W.

  • Clinical Social Worker
  • Jacksonville, IL
  • NPI 1972851905
  Authorized official Same address or phone

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349395200000",
    "number": "1346451853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E MORGAN ST",
            "address_2": "P.O. BOX 1304",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626502508",
            "telephone_number": "217-245-1655",
            "fax_number": "217-245-4742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E MORGAN ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626502508",
            "telephone_number": "217-245-1655",
            "fax_number": "217-245-4742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK PLACE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2012-10-05",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "ED",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "217-245-1655",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.C.S.W."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.003173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Jacksonville, IL
• Providers in Jacksonville, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.

Verify at the official NPI Registry.