Active NPI
Angela Renee Wilson, LPC
- Professional Counselor
- Mount Vernon, IL
National Provider Identifier
1467125419
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.016894
- Practice address
- 3 Cusumano Professional Plaza Dr
Mount Vernon, IL 62864-6736 - Phone
- (618) 267-3968
- NPI assigned
- Jul 27, 2021
- 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 | 178.016894 | IL | Primary |
Addresses
Primary practice location
3 Cusumano Professional Plaza Dr
Mount Vernon, IL 62864-6736
Mailing address
829 Oakland Ave
Mount Vernon, IL 62864-3526
Phone (618) 267-3968
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.016894 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627344000000",
"number": "1467125419",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "829 OAKLAND AVE",
"city": "MOUNT VERNON",
"state": "IL",
"postal_code": "628643526",
"telephone_number": "618-267-3968"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 CUSUMANO PROFESSIONAL PLAZA DR",
"city": "MOUNT VERNON",
"state": "IL",
"postal_code": "628646736",
"telephone_number": "618-267-3968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ANGELA",
"middle_name": "RENEE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-07-27",
"last_updated": "2021-07-27",
"certification_date": "2021-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.016894",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.