=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235911280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARGARET PERRY, LCSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2023
-----------------------------------------------------
Last Update Date | 10/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 CARLINVILLE PLZ
-----------------------------------------------------
City | CARLINVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62626-1176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-705-4550
-----------------------------------------------------
Fax | 217-705-4213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 N CHARLES ST
-----------------------------------------------------
City | CARLINVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62626-1333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-705-4550
-----------------------------------------------------
Fax | 217-705-4213
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARGARET PERRY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 217-705-4550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------