Individual provider Active NPI

John Calloway Gilliam, BA

  • Mental Health Counselor
  • Louisa, KY
National Provider Identifier
1477091072
Registry record updated Sep 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
125 S Main Cross St
Louisa, KY 41230-1065
Phone
(606) 638-0938
NPI assigned
Feb 3, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

125 S Main Cross St
Louisa, KY 41230-1065

Mailing address

125 S Main Cross St
Louisa, KY 41230-1065
Phone (606) 638-0938

Other practice location 1

1203 American Greeting Card Rd
Corbin, KY 40701-4811
Phone (606) 528-7010

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
Credentials
Bachelor of Arts

Practice roles

OrganizationSpecialtyStatusNew patients
Cumberland River Behavioral Health, Inc PastSince Aug 26, 2002 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.

NPI Registry JSON

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

{
    "created_epoch": "1486080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663545600000",
    "number": "1477091072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 S MAIN CROSS ST",
            "city": "LOUISA",
            "state": "KY",
            "postal_code": "412301065",
            "telephone_number": "606-638-0938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 S MAIN CROSS ST",
            "city": "LOUISA",
            "state": "KY",
            "postal_code": "412301065",
            "telephone_number": "606-638-0938"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1203 American Greeting Card Rd",
            "address_purpose": "LOCATION",
            "city": "Corbin",
            "state": "KY",
            "postal_code": "407014811",
            "country_code": "US",
            "telephone_number": "606-528-7010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "JOHN",
        "middle_name": "CALLOWAY",
        "credential": "BA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-03",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisa, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.

Verify at the official NPI Registry.