Angela Gilles, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149019012 Issued in IL

Practice address

5400 W Landens Way Apt 13a
Peoria, IL 61615-9223

Phone

(309) 966-0068

Fax

(309) 966-0266

NPI assigned

Dec 27, 2016

Reactivated

Aug 8, 2018

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

Other names 1

• Angela Black Former name

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.

• Melissa Shane Counseling Services LLC

  • Community/Behavioral Health Agency
  • Peoria, IL
  • NPI 1083125298
  NPD (past)

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

{
    "created_epoch": "1482796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1861937955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 W LANDENS WAY APT 13A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616159223",
            "telephone_number": "309-966-0068",
            "fax_number": "309-966-0266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 W LANDENS WAY APT 13A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616159223",
            "telephone_number": "309-966-0068",
            "fax_number": "309-966-0266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLES",
        "first_name": "ANGELA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-27",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "deactivation_date": "2018-03-08",
        "reactivation_date": "2018-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149019012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "BLACK",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• George Carlton Gilbert, M.D.
• Thomas Patrick Gilfillan, D.D.S.
• Debra N Gill, SPEECH THERAPIST
• Heather A Gill, PT
• Nicole Marie Gill, NP-C
• Christopher Michael Gillette, PHARM D., BCPP
• Keri M Gillette, COTA
• Cynthia L Gilmer, LCSW
• Karen Leslie Gilmore, LCSW
• Robert Kenton Gilmore, D.M.D.

• Clinical Social Worker in Peoria, IL
• Providers in Peoria, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 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.