Active NPI
Donna Southard, MA LCPC
- Professional Counselor
- Lansing, IL
National Provider Identifier
1649691924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180003601
- Practice address
- 2325 177TH St
Lansing, IL 60438-1722 - Phone
- (708) 895-7310
- NPI assigned
- Jan 3, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180003601 | IL | Primary |
Addresses
Primary practice location
2325 177TH St
Lansing, IL 60438-1722
Mailing address
1701 Forsythia St SE
Demotte, IN 46310-8264
Phone (219) 472-1757
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180003601 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Leaf Resources | Past | Accepting new patients |
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.
-
- Mental Health Counselor
- Lansing, IL
- NPI 1508824830
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1388707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388707200000",
"number": "1649691924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1701 FORSYTHIA ST SE",
"city": "DEMOTTE",
"state": "IN",
"postal_code": "463108264",
"telephone_number": "219-472-1757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2325 177TH ST",
"city": "LANSING",
"state": "IL",
"postal_code": "604381722",
"telephone_number": "708-895-7310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHARD",
"first_name": "DONNA",
"credential": "MA LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-01-03",
"last_updated": "2014-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180003601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lansing, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.