Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1174680995 Deactivated / Inactive NPI Male Practitioner

Charles Sanford Clyde , LPC

Counselor - Professional • Fairview Heights, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Charles Clyde has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date January 02, 2007
NPI Deactivation Date November 29, 2017
Total Practice Duration ~10 Years of Practice (2007 – 2017)

Professional Overview & Biography Verified Profile Summary

Charles Clyde, LPC was a registered Counselor - Professional practicing in Fairview Heights, IL. Throughout an active medical career spanning 10 years, Charles Clyde provided care at the practice location at 125 N RUBY LN until profile deactivation on 2017-11-29.

Practice Location & Contact Primary Location

Practice Address

125 N Ruby Ln

Fairview Heights, IL 622081926

Telephone 6183984226
Fax 6183981759
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Counselor - Professional in Fairview Heights, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 18.0 Yrs
State Avg: 17.0 Yrs
Regional Practice Density
9 Specialists

Practicing in Fairview Heights, IL (9683 Statewide)

Telehealth Adoption Rate
11.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Counselor - Professional Primary Specialty

NUCC Taxonomy Code: 101YP2500X

Definition to come...

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

10 Associated Practitioners
Byron Loy , LCPC, PLPC, CRADC

Counselor - Mental Health

NPI 1043426752

Licensed Clinical Professional Counselor, PLPC, CRADC

Ebele Iloabachie

Nurse Practitioner - Psychiatric/Mental Health

NPI 1093050841
Kathrine Warring , OTRL

Occupational Therapist

NPI 1124193131

Occupational Therapist Registered & Licensed

Glenn Agape Montero , MSN, ARN, PMHNP-BC

Nurse Practitioner - Psychiatric/Mental Health

NPI 1124805189

Master of Science in Nursing, ARN, Psychiatric-Mental Health Nurse Practitioner (Board Certified)

Susan Norsigian , LCPC

Counselor - Mental Health

NPI 1194939256

Licensed Clinical Professional Counselor

Marian Jackson , LCSW

Social Worker - Clinical

NPI 1427394485

Licensed Clinical Social Worker

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated November 29, 2017

Record deactivated on November 29, 2017

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 125 N RUBY LN, FAIRVIEW HEIGHTS, IL 622081926 (Tel: 6183984226)

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Updated Business Mailing Address July 08, 2007

Registered at 125 N RUBY LN, FAIRVIEW HEIGHTS, IL 622081926 (Tel: 6183984226)

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Provider Name / Credentials Updated July 08, 2007

Recorded as CHARLES CLYDE, LPC

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Counselor

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Initial NPI Registration & Enumeration January 02, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1174680995
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 02, 2007
Last Update: July 08, 2007
Deactivation Date: November 29, 2017

Mailing Address

125 N Ruby Ln

Fairview Heights, IL 622081926

Phone: 6183984226

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.