Mikaella Mari Walker, M.A., LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180.007453 Issued in IL

Practice address

302 S 3Rd St
Greenville, IL 62246-1733

Phone

(618) 292-7797

Fax

(618) 493-4178

NPI assigned

Jan 15, 2009

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• The Lighthouse Therapy Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Greenville, IL
  • NPI 1659070738
  NPD Authorized official

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

{
    "created_epoch": "1231977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1902043706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 S 3RD ST",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622461733",
            "telephone_number": "618-292-7797",
            "fax_number": "618-493-4178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 S 3RD ST",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622461733",
            "telephone_number": "618-292-7797",
            "fax_number": "618-493-4178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "MIKAELLA",
        "middle_name": "MARI",
        "name_prefix": "Mrs.",
        "credential": "M.A., LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-15",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.007453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCPC",
            "identifier": "180007453",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Elizabeth Vandenbergh, P.T.
• Jordan Vandyke
• Damon T Vincent, MD
• Vituity - Illinois Infectious Disease Specialists, P.C.
• Billy Lee Viviano, DC
• Watsons Drug Store Inc
• Angelica Wehrle
• Aften Wessel, FNP
• Anna White
• Lacey Wiegmann

• Mental Health Counselor in Greenville, IL
• Providers in Greenville, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; 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.