Active NPI
Jefferson Williams, LCPC
- Professional Counselor
- Bloomington, IL
National Provider Identifier
1891286191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180004426
- Practice address
- 211 N Veterans Pkwy Ste 1
Bloomington, IL 61704-3568 - Phone
- (309) 663-2229
- NPI assigned
- May 22, 2018
- 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 | 180004426 | IL | Primary |
Addresses
Primary practice location
211 N Veterans Pkwy Ste 1
Bloomington, IL 61704-3568
Mailing address
211 N Veterans Pkwy Ste 1
Bloomington, IL 61704-3568
Phone (309) 663-2229
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 |
|---|---|---|---|
| 180004426 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Agape Counseling, LTD | Professional | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526947200000",
"number": "1891286191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 N VETERANS PKWY STE 1",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617043568",
"telephone_number": "309-663-2229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 N VETERANS PKWY STE 1",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617043568",
"telephone_number": "309-663-2229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "JEFFERSON",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-22",
"last_updated": "2018-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180004426",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 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.