Micah Jr Caldwell, MS, LPCC, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.013357 Issued in IL

Practice address

3440 Clinton Ave
Berwyn, IL 60402-3322

Phone

(708) 695-4841

NPI assigned

Feb 20, 2013

Last updated

Apr 18, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Other names 1

• Micah J Russell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Micah Caldwell Therapy PLLC

  • Adult Mental Health Clinic/Center
  • Berwyn, IL
  • NPI 1376230656
  NPD Authorized official

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

{
    "created_epoch": "1361318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681776000000",
    "number": "1487994919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7301 W 25TH ST # 130",
            "city": "NORTH RIVERSIDE",
            "state": "IL",
            "postal_code": "605461409",
            "telephone_number": "708-695-4841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3440 CLINTON AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023322",
            "telephone_number": "708-695-4841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALDWELL",
        "first_name": "MICAH",
        "middle_name": "JR",
        "name_prefix": "Mr.",
        "credential": "MS, LPCC, LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-20",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "16627-130",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "LPCC5913",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.013357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICAH",
            "last_name": "RUSSELL",
            "middle_name": "J",
            "credential": "SAC-IT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ann Lake Bryant, M.A.
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• Megan Burg
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• Esteban Andres Cabezas Rubio, MD
• Camilleri Medical Center LTD
• Mark Camilleri, DPM
• Elizabeth Wilma Canelas, M.D.
• Beatriz Noemi Cano, LCPC
• Claudelia Cano, FNP

• Professional Counselor in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2023; 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.