Active NPI
Caterina Nicole Richardson, LICENSED CLINICAL PR
- Mental Health Counselor
- Pekin, IL
National Provider Identifier
1366400806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 180004822
- Practice address
- 3248 Vandever Avenue
Pekin, IL 61554 - Phone
- (309) 347-5579
- Fax
- (309) 347-4264
- NPI assigned
- May 3, 2006
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 180004822 | IL | Primary |
Addresses
Primary practice location
3248 Vandever Avenue
Pekin, IL 61554
Mailing address
3248 Vandever Avenue
Pekin, IL 61554
Phone (309) 347-5579
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 |
|---|---|---|---|
| 180004822 | IL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234137600000",
"number": "1366400806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3248 VANDEVER AVENUE",
"city": "PEKIN",
"state": "IL",
"postal_code": "61554",
"telephone_number": "309-347-5579",
"fax_number": "309-347-4264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3248 VANDEVER AVENUE",
"city": "PEKIN",
"state": "IL",
"postal_code": "61554",
"telephone_number": "309-347-5579",
"fax_number": "309-347-4264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDSON",
"first_name": "CATERINA",
"middle_name": "NICOLE",
"credential": "LICENSED CLINICAL PR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-03",
"last_updated": "2009-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "180004822",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pekin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.