Alyssa L Park, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180008205 Issued in IL

Practice address

5220 S 6TH Street Rd
Suite 2400
Springfield, IL 62703-5735

Phone

(217) 757-7700

Fax

(217) 757-7799

NPI assigned

Nov 19, 2012

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

• Alyssa L Fagan 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mental Health Centers of Central Illinois

  dba Memorial Behavioral Health - Springfield Children's Center

  • Adolescent and Children Mental Health Clinic/Center
  • Springfield, IL
  • NPI 1457505125
  NPD (past)

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

{
    "created_epoch": "1353283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381449600000",
    "number": "1891039541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N 8TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627026324",
            "telephone_number": "217-525-1064",
            "fax_number": "217-525-1651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5220 S 6TH STREET RD",
            "address_2": "SUITE 2400",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627035735",
            "telephone_number": "217-757-7700",
            "fax_number": "217-757-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ALYSSA",
        "middle_name": "L",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-19",
        "last_updated": "2013-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180008205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "FAGAN",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John M Pargulski, D.O.
• Ankit Rajeshkumar Parikh, M.D.
• Brad Paris, M.D.
• Erin M Paris, R.D.
• Jacob Glenn Parish, ATC
• Robert M. Parker, DPM
• Clayton Gerald Parks, M.D.
• Rachel D Parks, NP
• Aubrey Lynn Ferris Parnell
• Laura Parrack, FNP-BC

• Professional Counselor in Springfield, IL
• Providers in Springfield, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2013; 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.