Mary J Wilson, MS LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180002360 Issued in IL

Practice address

123 S 10TH
Suite 510
Mt Vernon, IL 62864

Phone

(618) 242-8139

Fax

(618) 242-8141

NPI assigned

Sep 22, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

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.

• Mt. Vernon Counseling Center, Inc.

  • Clinical Social Worker
  • Fairfield, IL
  • NPI 1558487090
  NPD (past)

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210636800000",
    "number": "1609975705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 S 10TH",
            "address_2": "SUITE 510",
            "city": "MT VERNON",
            "state": "IL",
            "postal_code": "62864",
            "telephone_number": "618-242-8139",
            "fax_number": "618-242-8141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 S 10TH",
            "address_2": "SUITE 510",
            "city": "MT VERNON",
            "state": "IL",
            "postal_code": "62864",
            "telephone_number": "618-242-8139",
            "fax_number": "618-242-8141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MARY",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "MS LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2008-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180002360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "180002360",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jerrold C Willis, MD
• John Ryan Willis, MD
• Vicky Michelle Willis, HEARING INSTURMENT S
• Angela Renee Wilson, LPC
• Elesha Wilson, LPN
• Ronda Kaye Wilson, LPN
• Sarah Wilson, FNP-C
• Pamela Winder, BCBA
• Kathleen Winkelmann, BS
• Jade Winne, MHP

• Professional Counselor in Mt Vernon, IL
• Providers in Mt Vernon, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; 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.