Nicole Costello, MS.PSY,CRADC,MOUD,CS

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

14770 Issued in MO

Practice address

2919 E 4TH St
Corporate Home Base Assignment
Joplin, MO 64801-1625

Phone

(417) 782-7966

Fax

(417) 624-4558

NPI assigned

Jul 23, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Other identifiers 1

Other names 1

• Niki Costello Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• BHG Lxxiv, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Joplin, MO
  • NPI 1437860772

  Methadone

  NPD (past)
• BHG Lxxiv, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • West Plains, MO
  • NPI 1710698055

  Methadone

  NPD (past)
• BHG Xxviii, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • West Plains, MO
  • NPI 1164833877

  Methadone

  NPD (past)
• Vcphcs XV, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Joplin, MO
  • NPI 1144666264

  Methadone

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767744000000",
    "number": "1013526318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2919 E 4TH ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648011625",
            "telephone_number": "503-983-1621",
            "fax_number": "417-624-4558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2919 E 4TH ST",
            "address_2": "CORPORATE HOME BASE ASSIGNMENT",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648011625",
            "telephone_number": "417-782-7966",
            "fax_number": "417-624-4558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1639 Bruce Smith Pkwy",
            "address_purpose": "LOCATION",
            "city": "West Plains",
            "state": "MO",
            "postal_code": "657757691",
            "country_code": "US",
            "telephone_number": "417-257-1833",
            "fax_number": "417-256-0488",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2534 Campbell St Ste B",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641082730",
            "country_code": "US",
            "telephone_number": "816-283-3877",
            "fax_number": "816-283-3310",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "404 E Battlefield St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658074802",
            "country_code": "US",
            "telephone_number": "417-865-8045",
            "fax_number": "417-865-1007",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "204 Kimberly Ct",
            "address_2": "Remote Home Office",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "MO",
            "postal_code": "630905294",
            "country_code": "US",
            "telephone_number": "503-983-1621",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1369 N Westwood Blvd",
            "address_purpose": "LOCATION",
            "city": "Poplar Bluff",
            "state": "MO",
            "postal_code": "639013313",
            "country_code": "US",
            "telephone_number": "573-772-7937",
            "fax_number": "573-778-1315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "NICOLE",
        "credential": "MS.PSY,CRADC,MOUD,CS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-23",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MO",
            "license": "14770",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OR",
            "license": "93-6002307",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MO",
            "license": "1922",
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "MO",
            "license": "14770",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MO",
            "license": "14770",
            "primary": false
        },
        {
            "code": "247000000X",
            "taxonomy_group": "",
            "desc": "Technician, Health Information",
            "state": "MO",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122994",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "niki.costello@bhgrecovery.com",
            "affiliation": "Y",
            "endpointDescription": "VPN secured and approved email to send encrypted PHI",
            "affiliationName": "BHG LXXXIX LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "204 Kimberly Ct",
            "address_2": "Remote Home Office",
            "city": "Washington",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630905294",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NIKI",
            "last_name": "COSTELLO",
            "credential": "MS.PSY,CRADC,MOUD,CS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• All providers in Joplin, MO
• Community/Behavioral Health Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.