Active NPI
Carl L Wilson, LPC
- Mental Health Counselor
- Chicago, IL
National Provider Identifier
1467189068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 178.017598
- Practice address
- 858 N Clark St Ste 203
Chicago, IL 60610-6804 - Phone
- (312) 298-9224
- NPI assigned
- Aug 3, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 178.017598 | IL | Primary |
Addresses
Primary practice location
858 N Clark St Ste 203
Chicago, IL 60610-6804
Mailing address
1344 Ridgeland Ave
Berwyn, IL 60402-1143
Phone (312) 934-4805
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 |
|---|---|---|---|
| 178.017598 | IL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Siv Consultation, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Chicago, IL
- NPI 1346608718
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659484800000",
"number": "1467189068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1344 RIDGELAND AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604021143",
"telephone_number": "312-934-4805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "858 N CLARK ST STE 203",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606106804",
"telephone_number": "312-298-9224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CARL",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-08-03",
"last_updated": "2022-08-03",
"certification_date": "2022-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "178.017598",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.