NPIMap

Organization Active NPI

Abc Counseling PC

  • Clinical Social Worker
  • Lake Villa, IL
National Provider Identifier
1407112576
Registry record updated Apr 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
060-006208 Issued in IL
Legal business name
ABC COUNSELING PC
Practice address
25283 W Timber LN
Lake Villa, IL 60046-7372
Phone
(847) 587-2222
Fax
(847) 587-7656
NPI assigned
Apr 3, 2012
Last updated
Apr 9, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2012

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

Authorized official

Name
David Richard Mitchell, MSW, LCSW
Title
President
Phone
(847) 587-2222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 060-006208 IL Primary

Addresses

Primary practice location

25283 W Timber LN
Lake Villa, IL 60046-7372

Mailing address

25283 W Timber LN
Lake Villa, IL 60046-7372
Phone (847) 587-2222

Other identifiers 4

IdentifierTypeStateIssuer
149-001264OtherLCSW
0660-006208OtherPRO. SERVICE CORP LIC. #
L 2080-032716OtherTRICARE/CHAMPUS
049-001264OtherBLUE SHIELD PROVIDER #

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333929600000",
    "number": "1407112576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25283 W TIMBER LN",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600467372",
            "telephone_number": "847-587-2222",
            "fax_number": "847-587-7656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25283 W TIMBER LN",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600467372",
            "telephone_number": "847-587-2222",
            "fax_number": "847-587-7656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABC COUNSELING PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-03",
        "last_updated": "2012-04-09",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-587-2222",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "060-006208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "149-001264",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRO. SERVICE CORP LIC. #",
            "identifier": "0660-006208",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE/CHAMPUS",
            "identifier": "L 2080-032716",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "049-001264",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Villa, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2012; 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.