Northside Counseling Inc

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180000932 Issued in IL

Legal business name

NORTHSIDE COUNSELING INC

Practice address

20130 Samara TRL
Lake Ann, MI 49650-9685

Phone

(773) 960-8359

NPI assigned

Nov 27, 2006

Organization subpart

No

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

Authorized official

Name

Susan Thompson, LCPC, LPC

Title

President

Phone

(773) 960-8359

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467072000000",
    "number": "1528134277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20130 SAMARA TRL",
            "city": "LAKE ANN",
            "state": "MI",
            "postal_code": "496509685",
            "telephone_number": "773-960-8359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20130 SAMARA TRL",
            "city": "LAKE ANN",
            "state": "MI",
            "postal_code": "496509685",
            "telephone_number": "773-960-8359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE COUNSELING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2016-06-28",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-960-8359",
        "authorized_official_credential": "LCPC, LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180000932",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL",
            "identifier": "0001634445",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "103637507",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cameron Mills, AT
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• Northern Pediatric Therapy PLLC
• Township of Almira

• Professional Counselor in Lake Ann, MI
• Providers in Lake Ann, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2016; 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.