Active NPI
Pamela Sue Waterman, MA, LCPC
- Professional Counselor
- Decatur, IL
National Provider Identifier
1407001357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.006107
- Practice address
- 720 E. Wood St.
Decatur, IL 62523 - Phone
- (217) 425-9931
- Fax
- (217) 425-9701
- NPI assigned
- Nov 19, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | 180.006107 | IL | Primary |
Addresses
Primary practice location
720 E. Wood St.
Decatur, IL 62523
Mailing address
720 E Wood St
Decatur, IL 62523-1155
Phone (217) 425-9931
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.006107 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227052800000",
"number": "1407001357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 E WOOD ST",
"city": "DECATUR",
"state": "IL",
"postal_code": "625231155",
"telephone_number": "217-425-9931",
"fax_number": "217-425-9701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 E. WOOD ST.",
"city": "DECATUR",
"state": "IL",
"postal_code": "62523",
"telephone_number": "217-425-9931",
"fax_number": "217-425-9701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERMAN",
"first_name": "PAMELA",
"middle_name": "SUE",
"credential": "MA, LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-19",
"last_updated": "2008-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.006107",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.