Active NPI
Tina Martin, LCP
- Professional Counselor
- Metropolis, IL
National Provider Identifier
1992157283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.003185
- Practice address
- 206 W 5TH St
Metropolis, IL 62960-1810 - Phone
- (618) 524-9368
- NPI assigned
- Jul 11, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Professional Counselor | 101YP2500X | 178.003185 | IL | Primary |
Addresses
Primary practice location
206 W 5TH St
Metropolis, IL 62960-1810
Mailing address
595 Barter Rd
Harrisburg, IL 62946-4102
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 |
|---|---|---|---|
| 178.003185 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471305600000",
"number": "1992157283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "595 BARTER RD",
"city": "HARRISBURG",
"state": "IL",
"postal_code": "629464102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 W 5TH ST",
"city": "METROPOLIS",
"state": "IL",
"postal_code": "629601810",
"telephone_number": "618-524-9368"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "TINA",
"credential": "LCP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-11",
"last_updated": "2016-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.003185",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Metropolis, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.