Active NPI
Kim A Callaway, LCPC
- Professional Counselor
- Edwardsville, IL
National Provider Identifier
1376825950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.007949
- Practice address
- 40B Edwardsville Prof Park
Edwardsville, IL 62025-3602 - Phone
- (618) 795-2697
- Fax
- (618) 731-4178
- NPI assigned
- Sep 9, 2011
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.007949 | IL | Primary |
Addresses
Primary practice location
40B Edwardsville Prof Park
Edwardsville, IL 62025-3602
Mailing address
PO Box 101
Edwardsville, IL 62025-0101
Phone (618) 795-2697
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 |
|---|---|---|---|
| 180.007949 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Radzom Counseling LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Edwardsville, IL
- NPI 1639462948
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315526400000",
"number": "1376825950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 101",
"city": "EDWARDSVILLE",
"state": "IL",
"postal_code": "620250101",
"telephone_number": "618-795-2697",
"fax_number": "618-731-4178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40B EDWARDSVILLE PROF PARK",
"city": "EDWARDSVILLE",
"state": "IL",
"postal_code": "620253602",
"telephone_number": "618-795-2697",
"fax_number": "618-731-4178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALLAWAY",
"first_name": "KIM",
"middle_name": "A",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-09",
"last_updated": "2011-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.007949",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edwardsville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.