Active NPI
Carmen Tate
- Professional Counselor
- Hazel Crest, IL
National Provider Identifier
1972111334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180009380
- Practice address
- 2803 Larkspur LN
Hazel Crest, IL 60429-2145 - Phone
- (708) 608-3241
- NPI assigned
- Jul 21, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 150102674 | ||
| Case Manager/Care Coordinator | 171M00000X | 42113793 | ||
| Rehabilitation Counselor | 225C00000X | 110546 | ||
| Professional Counselor | 101YP2500X | 180009380 | Primary |
Addresses
Primary practice location
2803 Larkspur LN
Hazel Crest, IL 60429-2145
Mailing address
2803 Larkspur LN
Hazel Crest, IL 60429-2145
Phone (708) 305-1193
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47-4411020 | Medicaid | IL | |
| 47-4411020 | Other | PRIVATE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595289600000",
"number": "1972111334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2803 LARKSPUR LN",
"city": "HAZEL CREST",
"state": "IL",
"postal_code": "604292145",
"telephone_number": "708-305-1193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2803 LARKSPUR LN",
"city": "HAZEL CREST",
"state": "IL",
"postal_code": "604292145",
"telephone_number": "708-608-3241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TATE",
"first_name": "CARMEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-21",
"last_updated": "2020-07-21",
"certification_date": "2020-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": "150102674",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": "42113793",
"primary": false
},
{
"code": "225C00000X",
"taxonomy_group": "",
"desc": "Rehabilitation Counselor",
"state": null,
"license": "110546",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": "180009380",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47-4411020",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIVATE",
"identifier": "47-4411020",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Hazel Crest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.