Active NPI
Revell Burton, CADC AAS
- Addiction (Substance Use Disorder) Counselor
- Waukegan, IL
National Provider Identifier
1689948416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 22561
- Practice address
- 3002 Grand Ave
Waukegan, IL 60085-2321 - Phone
- (847) 377-8200
- Fax
- (847) 360-7377
- NPI assigned
- Feb 24, 2012
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 22561 | IL | Primary |
Addresses
Primary practice location
3002 Grand Ave
Waukegan, IL 60085-2321
Mailing address
3002 Grand Ave
Waukegan, IL 60085-2321
Phone (847) 377-8200
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
- Credentials
- Associate of Applied Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22561 | IL | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330041600000",
"number": "1689948416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3002 GRAND AVE",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600852321",
"telephone_number": "847-377-8200",
"fax_number": "847-360-7377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3002 GRAND AVE",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600852321",
"telephone_number": "847-377-8200",
"fax_number": "847-360-7377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURTON",
"first_name": "REVELL",
"credential": "CADC AAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-02-24",
"last_updated": "2012-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IL",
"license": "22561",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.