Active NPI
Tina Sue Otto, LPC, CADC
- Addiction (Substance Use Disorder) Counselor
- Vandalia, IL
National Provider Identifier
1891813465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 17890
- Practice address
- 421 W Main St
Vandalia, IL 62471-2214 - Phone
- (618) 283-4229
- NPI assigned
- Mar 26, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 17890 | IL | Primary |
| Mental Health Counselor | 101YM0800X | 178.006052 | IL |
Addresses
Primary practice location
421 W Main St
Vandalia, IL 62471-2214
Mailing address
RR 1 Box 300C
Ramsey, IL 62080-9402
Phone (618) 423-9590
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 |
|---|---|---|---|
| 17890 | IL | MD | Addiction (Substance Use Disorder) Counselor |
| 178.006052 | IL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241481600000",
"number": "1891813465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RR 1 BOX 300C",
"city": "RAMSEY",
"state": "IL",
"postal_code": "620809402",
"telephone_number": "618-423-9590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "421 W MAIN ST",
"city": "VANDALIA",
"state": "IL",
"postal_code": "624712214",
"telephone_number": "618-283-4229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTTO",
"first_name": "TINA",
"middle_name": "SUE",
"credential": "LPC, CADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-26",
"last_updated": "2009-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IL",
"license": "17890",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "178.006052",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vandalia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.