Active NPI
Michael Taylor, LPHA, LCPC, CRC
- Professional Counselor
- Centralia, IL
National Provider Identifier
1811419435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180003710
- Practice address
- 904 E. Martin Luther King Drive
Centralia, IL 62801 - Phone
- (618) 533-1391
- Fax
- (618) 533-0012
- NPI assigned
- Jul 14, 2017
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180003710 | IL | Primary |
Addresses
Primary practice location
904 E. Martin Luther King Drive
Centralia, IL 62801
Mailing address
904 E. Martin Luther King Drive
Centralia, IL 62801
Phone (618) 533-1391
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 370915481007 | Medicaid | IL |
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 |
|---|---|---|---|
| 180003710 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1811419435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "904 E. MARTIN LUTHER KING DRIVE",
"city": "CENTRALIA",
"state": "IL",
"postal_code": "62801",
"telephone_number": "618-533-1391",
"fax_number": "618-533-0012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "904 E. MARTIN LUTHER KING DRIVE",
"city": "CENTRALIA",
"state": "IL",
"postal_code": "62801",
"telephone_number": "618-533-1391",
"fax_number": "618-533-0012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYLOR",
"first_name": "MICHAEL",
"credential": "LPHA, LCPC, CRC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-14",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180003710",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "370915481007",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Centralia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.