MR. JOHN C SAMPLE (NPI# 1437374824) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437374824 |
| Entity Type | Individual |
| Full Name | MR. JOHN C SAMPLE |
| Credential | LCPC |
| Practice Address |
23616 157th Ave N Cordova IL 61242-9771 |
| Mailing Address |
17204 River Rd N Cordova IL 61242-9735 |
| Practice Telephone | 3096542402 |
| Practice Fax Number | 3096542885 |
| Mailing Telephone | 3096542104 |
| Mailing Fax Number | 3096542885 |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
IL | Behavioral Health & Social Service Providers |
| Street Address |
23616 157TH AVE N |
| City | CORDOVA |
| State | IL |
| Zip Code | 61242-9771 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003025404 | Mary A Chaney | Developmental Therapist | 1334 2nd St S, Cordova, IL 61242-9713 | 2007-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497355390 | Delia M. Reyes | Nurse Practitioner | 705 2nd St., Cordova, AK 99574 | 2020-10-29 |
| 1376143289 | Rachel Slovsky | Behavior Technician | 8350 Walnut Grove Rd, Cordova, TN 38018-7392 | 2020-10-29 |
| 1588264428 | Shaquia Janai Harris | Behavior Technician | 1079 N Houston Levee Road, Cordova, TN 38018 | 2020-10-29 |
| 1366041493 | Cynthia Brantley | Behavior Technician | 1079 N Houston Levee Rd, Cordova, TN 38018 | 2020-10-20 |
| 1437757960 | Stephanie Cook | Nurse Practitioner | 8532 Wood Mills Dr W, Cordova, TN 38016-6169 | 2020-10-16 |
| 1922606953 | Latonya Rochelle Addison | Licensed Practical Nurse | 8855 N Cortona Cir, Cordova, TN 38018-6978 | 2020-10-12 |
| 1144836404 | Walter J. Green | Counselor | 1120 Mossy Knoll Dr, Cordova, TN 38018-6671 | 2020-09-21 |
| 1548876303 | Kimberly Hearon | Registered Nurse | 6890 Lagrange Grove Dr, Cordova, TN 38018-2875 | 2020-09-17 |
| 1215543251 | Kenyatta Pugh | Home Health Aide | 1176 Vickery Ln Ste 200, Cordova, TN 38016-0631 | 2020-09-16 |
| 1063027043 | Marisa Cozine | Speech-Language Pathologist | 7837 Elmington Dr Apt 208, Cordova, TN 38018-2237 | 2020-09-15 |
| Find all providers in CORDOVA | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144836404 | Walter J. Green | Counselor | 1120 Mossy Knoll Dr, Cordova, TN 38018-6671 | 2020-09-21 |
| 1124646799 | Triscilla D'anne Johnson | Counselor | 152 Timber Creek Dr Ste 4, Cordova, TN 38018-4237 | 2020-07-10 |
| 1467956573 | Jaimie Lee Walker | Counselor | 52 Timber Creek Dr, Cordova, TN 38018-4369 | 2018-03-22 |
| 1922512441 | Fredrick Gillam Jr. | Counselor | 815 Exocet Dr Ste 107, Cordova, TN 38018-2257 | 2017-11-20 |
| 1356776165 | Susan E.c. Powell | Counselor | 705 Second Street, Cordova, AK 99574 | 2013-09-11 |
| 1881950707 | August Geeter | Counselor | 8601 Pantherburn Trce, Cordova, TN 38018-3582 | 2012-04-04 |
| 1487806683 | Janet Lee Ferrell | Counselor | 1340 Siskin Drive, Cordova, TN 38016 | 2008-10-21 |
| 1780859678 | Septuri Uhurubey | Counselor | 2751 N Rockcreek Pkwy, Cordova, TN 38016-4653 | 2008-04-23 |
| 1598939654 | Katherine Mclean Wilson | Counselor | 110 Timber Creek Dr, Cordova, TN 38018-4279 | 2008-04-18 |
| 1376609602 | Lawrence Lynn Semrau | Counselor | 800 N Houston Levee Rd, Cordova, TN 38018-6614 | 2006-12-29 |
| Find all providers in CORDOVA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.