Active NPI
Michael Soucie
- Counselor
- Channahon, IL
National Provider Identifier
1902519432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 25259 S Reed St
Channahon, IL 60410-6003 - Phone
- (815) 467-0555
- NPI assigned
- Dec 29, 2022
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | IL | ||
| Clinical Social Worker | 1041C0700X | 149025186 | IL | |
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
25259 S Reed St
Channahon, IL 60410-6003
Mailing address
3301 Deer St Apt 1C
Woodridge, IL 60517-3246
Other practice location 1
409 North Route 53
Gardner, IL 60424
Phone (815) 237-0413
Other practice location 2
150 W High St
Morris, IL 60450-1497
Phone (815) 942-2932
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149025186 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683158400000",
"number": "1902519432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3301 DEER ST APT 1C",
"city": "WOODRIDGE",
"state": "IL",
"postal_code": "605173246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25259 S REED ST",
"city": "CHANNAHON",
"state": "IL",
"postal_code": "604106003",
"telephone_number": "815-467-0555"
}
],
"practiceLocations": [
{
"address_1": "409 North Route 53",
"address_purpose": "LOCATION",
"city": "Gardner",
"state": "IL",
"postal_code": "60424",
"country_code": "US",
"telephone_number": "815-237-0413",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "150 W High St",
"address_purpose": "LOCATION",
"city": "Morris",
"state": "IL",
"postal_code": "604501497",
"country_code": "US",
"telephone_number": "815-942-2932",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SOUCIE",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-12-29",
"last_updated": "2023-05-04",
"certification_date": "2023-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IL",
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149025186",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Channahon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.