Active NPI
Mary Kathryn Terrell, B.A.
- Counselor
- Belleville, IL
National Provider Identifier
1477894269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 178.016917
- Practice address
- 12 N 64TH St
Belleville, IL 62223-3809 - Phone
- (618) 877-4420
- NPI assigned
- Mar 5, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | |||
| Counselor | 101Y00000X | 178.016917 | IL | Primary |
Addresses
Primary practice location
12 N 64TH St
Belleville, IL 62223-3809
Mailing address
448 Wylie Dr Ste 400
Normal, IL 61761-5405
Phone (618) 512-1502
Other practice location 1
343 S Kirkwood Rd
Suite 200
Saint Louis, MO 63122-4015
Phone (314) 206-3400
Other names 1
- Katie Terrell
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.016917 | IL | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Live Well Counseling Services | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Social Worker
- Venedy, IL
- NPI 1881055838
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627430400000",
"number": "1477894269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "448 WYLIE DR STE 400",
"city": "NORMAL",
"state": "IL",
"postal_code": "617615405",
"telephone_number": "618-512-1502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 N 64TH ST",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622233809",
"telephone_number": "618-877-4420"
}
],
"practiceLocations": [
{
"address_1": "343 S Kirkwood Rd",
"address_2": "Suite 200",
"address_purpose": "LOCATION",
"city": "Saint Louis",
"state": "MO",
"postal_code": "631224015",
"country_code": "US",
"telephone_number": "314-206-3400",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TERRELL",
"first_name": "MARY",
"middle_name": "KATHRYN",
"credential": "B.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-05",
"last_updated": "2021-07-28",
"certification_date": "2021-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IL",
"license": "178.016917",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KATIE",
"last_name": "TERRELL",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Belleville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.