Roger P Anderson, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180.000673 Issued in IL

Practice address

3400 W New Leaf LN
Peoria, IL 61615-3311

Phone

(309) 692-6900

Fax

(309) 689-3086

NPI assigned

Jun 1, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1243814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243814400000",
    "number": "1497981815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 FAYETTE ST",
            "address_2": "PO BOX 1346",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033610",
            "telephone_number": "309-671-8000",
            "fax_number": "309-671-8039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 W NEW LEAF LN",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616153311",
            "telephone_number": "309-692-6900",
            "fax_number": "309-689-3086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "ROGER",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-01",
        "last_updated": "2009-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.000673",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Anderson, M.A.
• Lindsey Marie Anderson, PTA
• Madison Anderson
• Rachel Emily Anderson, OTR/L
• Richard Anderson, M.D.
• Scott William Anderson, DDS
• Thomas Anderson, O.D.
• Tracy R Anderson, MS, RD, LDN
• Diane Anderton, DNP
• Andrea Desatnick Counseling, PLLC

• Mental Health Counselor in Peoria, IL
• Providers in Peoria, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2009; 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.