Back to Basics Counseling, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

BACK TO BASICS COUNSELING, LLC

Practice address

106 N Main St
Decatur, IL 62523-1207

Phone

(217) 821-8269

NPI assigned

Jun 4, 2020

Organization subpart

No

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

Authorized official

Name

Jaymie L McCammonNPI 1194099853

Title

LCSW

Phone

(779) 220-0441

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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

• Jaymie L McCammon, LCSW

  • Clinical Social Worker
  • Decatur, IL
  • NPI 1194099853
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1591228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594944000000",
    "number": "1437773579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 N MAIN ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625231207",
            "telephone_number": "779-220-0441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 N MAIN ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625231207",
            "telephone_number": "217-821-8269"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3350 N MacArthur Rd",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625261449",
            "country_code": "US",
            "telephone_number": "217-821-8269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BACK TO BASICS COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-04",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A",
        "authorized_official_last_name": "MCCAMMON",
        "authorized_official_first_name": "JAYMIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "LCSW",
        "authorized_official_telephone_number": "779-220-0441"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI 1",
            "identifier": "1194099853",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Decatur, IL
• Providers in Decatur, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; 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.