NPIMap

Organization Active NPI

Centennial Counseling Center, PC

  • Mental Health Counselor
  • St Charles, IL
National Provider Identifier
1376544387
Registry record updated Feb 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
060-007517 Issued in IL
Legal business name
CENTENNIAL COUNSELING CENTER, PC
Practice address
1120 E Main St
Ste. 201
St Charles, IL 60174-2287
Phone
(630) 377-6613
Fax
(630) 377-6225
NPI assigned
Aug 2, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2023

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

Authorized official

Name
Timothy R Buhrt, PSYDNPI 1063408250
Title
Executive Director
Phone
(630) 377-6613

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 060-007517 IL Primary

Addresses

Primary practice location

1120 E Main St
Ste. 201
St Charles, IL 60174-2287

Mailing address

1120 E Main St
Ste. 201
St Charles, IL 60174-2287
Phone (630) 377-6613

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070206000185 IL Part B Supplier - Clinic/Group Practice 7416959390 Receives reassigned benefits from 29 practitioners
Practice locations: Yorkville, IL; St Charles, IL; Sandwich, IL

National Provider Directory

National Provider Directory

Locations

207 E Church St
Unit A
Sandwich, IL 60548
Phone (815) 786-6000

207 E Church St
Sandwich, IL 60548
Phone (815) 786-8606

1120 E Main St
Ste 201
St Charles, IL 60174
Phone (630) 377-6613

Practitioners & affiliated clinicians

Practitioners 82

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 82

NPI Registry JSON

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676332800000",
    "number": "1376544387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 E MAIN ST",
            "address_2": "STE. 201",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742287",
            "telephone_number": "630-377-6613",
            "fax_number": "630-377-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 E MAIN ST",
            "address_2": "STE. 201",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742287",
            "telephone_number": "630-377-6613",
            "fax_number": "630-377-6225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL COUNSELING CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-02",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A",
        "authorized_official_last_name": "BUHRT",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "630-377-6613",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "060-007517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.