Nicole Elise Anderson, LCSW
Individual provider Active NPI Mental Health Counselor · Normal, IL
NPI 1346900909 · NPPES record last updated Dec 23, 2021
Key facts
- NPI
- 1346900909
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 149.022401 (IL)
- Practice address
- 1105 Market St
Normal, IL 61761-3329 - Phone
- (309) 310-1629
- NPI assigned
- Dec 23, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.022401 | IL | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 149.022401 | IL | Yes |
Addresses
Primary practice location
1105 Market St
Normal, IL 61761-3329
Mailing address
1105 Market St
Normal, IL 61761-3329
Phone (309) 310-1629
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All providers in Normal, IL · Mental Health Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.