Active NPI
Phaidra Wills
- Professional Counselor
- Chicago, IL
National Provider Identifier
1861939258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180010477
- Practice address
- 3062 E 91St St
Chicago, IL 60617-4401 - Phone
- (773) 371-2978
- NPI assigned
- Jan 24, 2017
- Sex
- Female
- 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 | 180010477 | IL | Primary |
Addresses
Primary practice location
3062 E 91St St
Chicago, IL 60617-4401
Mailing address
3062 E 91St St
Chicago, IL 60617-4401
Phone (773) 371-2978
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 |
|---|---|---|---|
| 180010477 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522281600000",
"number": "1861939258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3062 E 91ST ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606174401",
"telephone_number": "773-371-2978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3062 E 91ST ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606174401",
"telephone_number": "773-371-2978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLS",
"first_name": "PHAIDRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-24",
"last_updated": "2018-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180010477",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.