Shari Tucker, LCPC
Individual provider Active NPI Professional Counselor · Rockton, IL
NPI 1619783065 · NPPES record last updated Dec 9, 2024
Key facts
- NPI
- 1619783065
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 180.015886 (IL)
- Practice address
- 420 N Blackhawk Blvd
Rockton, IL 61072-2002 - Phone
- (815) 222-6056
- NPI assigned
- Dec 9, 2024
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2009
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
- Sondermind PC
Practice addresses (Care Compare)
416 Main St
Suite 601
Peoria, IL 61602-3126
Phone (866) 630-0966
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250128001784 | IL | Practitioner - Mental Health Counselor | 3274062872 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.015886 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mental Health Specialty Group PA | Professional | Current |
Accepting new patients |
| Sondermind PC | Professional | Current |
Accepting new patients |
Locations
332 S Michigan Ave
Chicago, IL 60604
Phone (773) 633-7479
416 Main St
Ste 601
Peoria, IL 61602
Phone (309) 945-3305
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.015886 | IL | Yes |
Addresses
Primary practice location
420 N Blackhawk Blvd
Rockton, IL 61072-2002
Mailing address
420 N Blackhawk Blvd
Rockton, IL 61072-2002
Phone (815) 222-6056
Other providers in Rockton, IL
- Stateline Counseling Services LLC
- Cassandra Stear
- Cindy A Stear
- Anna Taylor
- Louis J Tisovec
- Stephanie Unger
- Joshua Vos
- Wal-Mart Stores, Inc Dba Wal-Mart
- Kristyn Diane Ward Powell
- Derek Michael Willging
All providers in Rockton, IL · Professional 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 Dec 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.