Cissi Mayberry

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

4110 N Water Tower PL
Mount Vernon, IL 62864-6295

Phone

(618) 242-8266

NPI assigned

Jun 11, 2021

Sex

Female

Sole proprietor

No

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

Practice roles

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.

• One Hope United

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mount Vernon, IL
  • NPI 1841539640
  NPD (past)

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

{
    "created_epoch": "1623369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1790353316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 JUNIPER DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628645942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 N WATER TOWER PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646295",
            "telephone_number": "618-242-8266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "CISSI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-11",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danilo Achy Martins, M.D.
• Angel Mason, CD(DONA)
• Susan E Massey, CNM, WHNP
• Ashley May, FNP
• Rachelle Ranae May
• Christopher N McAndrew, MA, ATC, CES
• Kevin Dale McBride, PHARM.D.
• McClellan CCSD #12
• Brittany McDonald, APRN
• Mary K McGarvey, COTA

• Mental Health Counselor in Mount Vernon, IL
• Providers in Mount Vernon, 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 Jun 11, 2021; 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.