Tina Yvonne Pettiford, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

178.006219 Issued in IL

Practice address

5501 N Park Dr
East Saint Louis, IL 62204-2121

Phone

(618) 244-5119

NPI assigned

Dec 27, 2011

Last updated

Dec 27, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other names 1

• Tina Yvonne Mitchell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• House of Prayer Christian Academy

  • Counselor
  • East Saint Louis, IL
  • NPI 1700155595
  NPD (past)

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

{
    "created_epoch": "1324944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324944000000",
    "number": "1366711939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3805 ROBIN DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642268",
            "telephone_number": "618-244-5119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 N PARK DR",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622042121",
            "telephone_number": "618-244-5119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIFORD",
        "first_name": "TINA",
        "middle_name": "YVONNE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-27",
        "last_updated": "2011-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "178.006219",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.006219",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.006219",
            "primary": true
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "IL",
            "license": "2341716",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "178.006219",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "MITCHELL",
            "middle_name": "YVONNE",
            "credential": "LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Charles V Nye Jr., M.D.
• Osh-Il Physicians Group LLC
• Rina S. Patney, M.D.
• Marianna Peterson, MSW
• Sandra Marie Pettiford, P. T.
• Verna J. Porter, MD
• Adam Pruett, RDN
• Kayla Ann Pryor, APRN
• Leah Pulley
• Pure Living Recovery and Rehabilition Center

• Professional Counselor in East Saint Louis, IL
• Providers in East Saint Louis, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2011; 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.