Individual provider Active NPI

Victor Robert Epperson, LCPC

  • Professional Counselor
  • Sandwich, IL
National Provider Identifier
1528638640
Registry record updated May 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180.016053 Issued in IL
Practice address
207 E Church St Unit a
Sandwich, IL 60548-2299
Phone
(815) 786-8606
Fax
(815) 786-1541
NPI assigned
Jun 30, 2021
Last updated
May 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 178.017017 IL
Professional Counselor 101YP2500X 180.016053 IL Primary

Addresses

Primary practice location

207 E Church St Unit a
Sandwich, IL 60548-2299

Mailing address

1120 E Main St Ste 201
St Charles, IL 60174-2287
Phone (630) 377-6613

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250516002903 IL Practitioner - Mental Health Counselor 8628596293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centennial Counseling Center, PCGroup PAC ID 7416959390, 26 clinicians

Practice addresses (Care Compare)

207 E Church St
Unit a
Sandwich, IL 60548-2299
Phone (815) 786-8606

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
178.017017ILMDMental Health Counselor
180.016053ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Centennial Counseling Center, PC Mental Health CurrentSince May 12, 2025 Accepting new patients
Edward Health Ventures Past Accepting new patients

Locations

207 E Church St
Unit A
Sandwich, IL 60548
Phone (815) 786-8606

1120 E Main St
Ste 201
St Charles, IL 60174
Phone (630) 377-6613

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1625011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747008000000",
    "number": "1528638640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 E MAIN ST STE 201",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742287",
            "telephone_number": "630-377-6613",
            "fax_number": "630-377-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E CHURCH ST UNIT A",
            "city": "SANDWICH",
            "state": "IL",
            "postal_code": "605482299",
            "telephone_number": "815-786-8606",
            "fax_number": "815-786-1541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EPPERSON",
        "first_name": "VICTOR",
        "middle_name": "ROBERT",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-30",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.017017",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.016053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandwich, IL

Sources for this page

Verify at the official NPI Registry.