Active NPI
Andrew R Wall, LCPC
- Professional Counselor
- Chicago, IL
National Provider Identifier
1376899799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180008228
- Practice address
- 2302 W North Ave
Unit 1E
Chicago, IL 60647-6260 - Phone
- (773) 551-7204
- Fax
- (773) 342-4200
- NPI assigned
- Aug 3, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 180008228 | IL | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 180008228 | IL | |
| Mental Health Counselor | 101YM0800X | 180008228 | IL | |
| Professional Counselor | 101YP2500X | 180008228 | IL | Primary |
Addresses
Primary practice location
2302 W North Ave
Unit 1E
Chicago, IL 60647-6260
Mailing address
2302 W North Ave
Unit 1E
Chicago, IL 60647-6260
Phone (773) 551-7204
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 23, 2024 through Jan 23, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180008228 | IL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412208000000",
"number": "1376899799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2302 W NORTH AVE",
"address_2": "UNIT 1E",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606476260",
"telephone_number": "773-551-7204",
"fax_number": "773-342-4200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2302 W NORTH AVE",
"address_2": "UNIT 1E",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606476260",
"telephone_number": "773-551-7204",
"fax_number": "773-342-4200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "ANDREW",
"middle_name": "R",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-03",
"last_updated": "2014-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IL",
"license": "180008228",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IL",
"license": "180008228",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "180008228",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180008228",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.