Sara Michelle Spencer

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

S15279381673 Issued in IL

Practice address

904 E. MLK Dr.
Centralia, IL 62801

Phone

(618) 533-1391

NPI assigned

Aug 8, 2012

Last updated

Aug 8, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Resource Center Inc.

  • Community/Behavioral Health Agency
  • Centralia, IL
  • NPI 1063765055
  NPD (past)

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

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344384000000",
    "number": "1720335722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 WESTHAVEN DR",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628015739",
            "telephone_number": "618-335-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 E. MLK DR.",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "62801",
            "telephone_number": "618-533-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "SARA",
        "middle_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-08",
        "last_updated": "2012-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "S15279381673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• KD Smith
• Brandon Snow
• Alicia Marie Snyder, BCBA
• Southern Illinois Case Coordination Services
• Stephanie Ann Sparks, MAPC
• Laura Spenner, PTA
• Dale H Spitler, L.C.S.W.
• St Mary's Hospital, Centralia, Illinois (SSM Health St. Mary's Hospital - Centralia)
• St. Mary's Hospital, Centralia, Illinois (SSM Health St. Mary's Hospital - Centralia)
• St. Mary's Hospital, Centralia, Illinois (SSM Health St. Mary's Hospital - Centralia)

• Mental Health Counselor in Centralia, IL
• Providers in Centralia, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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.

Verify at the official NPI Registry.