Active NPI
Wallace Sprugeon Colvin IV, MA
- Professional Counselor
- Chicago, IL
National Provider Identifier
1699490284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 2755 N Pine Grove Ave
Chicago, IL 60614-6109 - Phone
- (312) 259-2665
- NPI assigned
- Oct 6, 2022
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
2755 N Pine Grove Ave
Chicago, IL 60614-6109
Mailing address
500 E 33Rd St Apt 810
Chicago, IL 60616-4239
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
- Master of Arts
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Five Point Holistic Health | Professional | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665014400000",
"number": "1699490284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 E 33RD ST APT 810",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606164239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2755 N PINE GROVE AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606146109",
"telephone_number": "312-259-2665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLVIN",
"first_name": "WALLACE",
"middle_name": "SPRUGEON",
"name_suffix": "IV",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-10-06",
"last_updated": "2022-10-06",
"certification_date": "2022-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.