NPIMap

Organization Active NPI

Liberty Counseling Center, Inc

  • Community/Behavioral Health Agency
  • Jacksonville, IL
National Provider Identifier
1457658189
Registry record updated Feb 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
A-7302-0001-A Issued in IL
Legal business name
LIBERTY COUNSELING CENTER, INC
Practice address
1429 S Main St
Suite a
Jacksonville, IL 62650-3476
Phone
(217) 479-0691
Fax
(217) 478-2060
NPI assigned
Feb 15, 2011
Last updated
Feb 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2011

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

Authorized official

Name
Mrs. Sandra K Eyman, MS,CADC,MISAII
Title
President/Director
Phone
(217) 479-0691

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X A-7302-0001-A IL Primary

Addresses

Primary practice location

1429 S Main St
Suite a
Jacksonville, IL 62650-3476

Mailing address

1429 S Main St
Suite a
Jacksonville, IL 62650-3476
Phone (217) 479-0691

Other identifiers 1

IdentifierTypeStateIssuer
C/A-7302-0001-AMedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Liberty Counseling Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1429 S Main St
Ste A
South Jacksonville, IL 62650
Phone (217) 479-0691

NPI Registry JSON

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

{
    "created_epoch": "1297728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297728000000",
    "number": "1457658189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1429 S MAIN ST",
            "address_2": "SUITE A",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626503476",
            "telephone_number": "217-479-0691",
            "fax_number": "217-478-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1429 S MAIN ST",
            "address_2": "SUITE A",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626503476",
            "telephone_number": "217-479-0691",
            "fax_number": "217-478-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY COUNSELING CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-15",
        "last_updated": "2011-02-15",
        "status": "A",
        "authorized_official_last_name": "EYMAN",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT/DIRECTOR",
        "authorized_official_telephone_number": "217-479-0691",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS,CADC,MISAII"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "A-7302-0001-A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "C/A-7302-0001-A",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.

Verify at the official NPI Registry.