Tracie Michelle Donnelly – Counselor in Vandalia, IL

Key facts

NPI: 1558828392
Entity type: Individual (NPI type 1)
Primary specialty: Counselor 101Y00000X
Practice address: 1121 N 6TH St
Vandalia, IL 62471-1219
Phone: (618) 283-2222
NPI assigned: Feb 28, 2019
Sex: Female
Sole proprietor: Yes

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 and National Provider Directory roles.

Therapeutic, Education, and Career Services, Inc. Counselor · Marion, IL · NPI 1043631351

NPD (past) COUNSELOR

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Practice roles

Organization	Specialty	Status	New patients
Therapeutic, Education, and Career Services, Inc.	Counselor	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Counselor Group: 193400000X SINGLE SPECIALTY GROUP	101Y00000X			Yes

Addresses

Primary practice location

1121 N 6TH St
Vandalia, IL 62471-1219

Mailing address

1733 Moonglow Rd
Centralia, IL 62801-6767
Phone (618) 335-6708

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 28, 2019.

{
    "created_epoch": "1551312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551312000000",
    "number": "1558828392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1733 MOONGLOW RD",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628016767",
            "telephone_number": "618-335-6708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 N 6TH ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624711219",
            "telephone_number": "618-283-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "TRACIE",
        "middle_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-28",
        "last_updated": "2019-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vandalia, IL

All providers in Vandalia, IL · Counselor in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.