Laura Green, LCSW
Individual provider Active NPI Mental Health Counselor · Danville, IL
NPI 1003490673 · NPPES record last updated Aug 22, 2025
Key facts
- NPI
- 1003490673
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 103 E Liberty LN
Danville, IL 61832-1442 - Phone
- (309) 704-0034
- NPI assigned
- May 10, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Two Roads Wellness Clinic, LLC
Practice addresses (Care Compare)
3545 N Vermilion St
Danville, IL 61832-1100
Phone (217) 651-6801
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240124000671 | IL | Practitioner - Clinical Social Worker | 6901258193 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles (2 of 7)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Two Roads Wellness Clinic, LLC | Current |
Accepting new patients | |
| Two Roads Wellness Clinic, LLC | Current |
Accepting new patients |
Locations
3545 N Vermilion St
Danville, IL 61832
Phone (217) 442-8611
Networks
- devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
- IL PPO Downstate
- devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
- devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806
- IL HMO C-SNP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
103 E Liberty LN
Danville, IL 61832-1442
Mailing address
103 E Liberty LN
Danville, IL 61832-1442
Phone (309) 704-0034
Other names
- Laura Tallon
Other providers in Danville, IL
- Meredith S Grant
- Monica G Grant
- Emily Joan Graver
- Richard Allen Graves
- Damon C. Green
- Patsy Ann Green
- Danny Robert Grider
- Mary Ellen Grilly
- Bradley Wayne Grissom
- Taylor Grove
All providers in Danville, IL · Mental Health Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.