Active NPI
Carrie Ruth Colvin, LCPC
- Professional Counselor
- Libertyville, IL
National Provider Identifier
1902621287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.016552
- Practice address
- 1512 Artaius Pkwy Ste 200
Libertyville, IL 60048-5231 - Phone
- (847) 444-9244
- Fax
- (847) 461-1006
- NPI assigned
- Nov 20, 2024
- Sex
- Unspecified or another gender identity
- 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 | 180.016552 | IL | Primary |
Addresses
Primary practice location
1512 Artaius Pkwy Ste 200
Libertyville, IL 60048-5231
Mailing address
26736 N Circle Dr
Mundelein, IL 60060-3466
Phone (708) 845-8065
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 |
|---|---|---|---|
| 180.016552 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1732060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732060800000",
"number": "1902621287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26736 N CIRCLE DR",
"city": "MUNDELEIN",
"state": "IL",
"postal_code": "600603466",
"telephone_number": "708-845-8065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1512 ARTAIUS PKWY STE 200",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600485231",
"telephone_number": "847-444-9244",
"fax_number": "847-461-1006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLVIN",
"first_name": "CARRIE",
"middle_name": "RUTH",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2024-11-20",
"last_updated": "2024-11-20",
"certification_date": "2024-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.016552",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Libertyville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.