John Michael Walsh, LCPC,CADC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180009182 Issued in IL

Practice address

2052 3Rd Ave
Rock Island, IL 61201-8803

Phone

(309) 794-1097

Fax

(309) 794-1208

NPI assigned

Dec 21, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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 and National Provider Directory roles.

• Alcohol & Drug Education Clinic, Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Rock Island, IL
  • NPI 1326456914
  NPD (past) Authorized official

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

{
    "created_epoch": "1356048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404259200000",
    "number": "1841536794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2052 3RD AVE",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612018803",
            "telephone_number": "309-794-1097",
            "fax_number": "309-794-1208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2052 3RD AVE",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612018803",
            "telephone_number": "309-794-1097",
            "fax_number": "309-794-1208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "JOHN",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "LCPC,CADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-12-21",
        "last_updated": "2014-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180009182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #03991)
• Walgreen Co (Walgreens #04332)
• Sarah Walker, RN, SANE-A
• Brandi Wallace, MA
• Emily Renee Walsh
• Alex Walters
• Terri Lynn Walters
• Tian Wang, RPH
• Jennifer Michelle Ward, MA
• Wendi Jean Ward

• Professional Counselor in Rock Island, IL
• Providers in Rock Island, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2014; 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.