Nicolas Gudino Jr.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180010615 Issued in IL

Practice address

108 W Market St
Bloomington, IL 61701-3918

Phone

(309) 827-5351

Fax

(309) 829-6808

NPI assigned

Jan 2, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Edgewood Clinical Services, P.C.

  dba LifeStance

  • Psychologist
  • Naperville, IL
  • NPI 1295914646

  Mental Health

  Medicare reassignment Care Compare group NPD
• Edgewood Clinical Services, P.C.

  dba LifeStance

  • Community/Behavioral Health Agency
  • Naperville, IL
  • NPI 1366784837
  NPD (past)
• Psychology Specialists LTD

  dba LifeStance Health

  • Clinical Psychologist
  • Bloomington, IL
  • NPI 1053368605
  NPD (past)

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

{
    "created_epoch": "1388620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653523200000",
    "number": "1063833457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 W MARKET ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013918",
            "telephone_number": "309-827-5351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 W MARKET ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013918",
            "telephone_number": "309-827-5351",
            "fax_number": "309-829-6808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUDINO",
        "first_name": "NICOLAS",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-01-02",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180010615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Gruber, DPT
• Gregory V Guard, MD
• Guardian Headache & Pain Management Institute
• Guardian Headache & Pain Management Institute LLC
• Guardian Interventional Pain Management Institute LLC
• Stephanie M Guerra
• Bhawna Gupta, PT
• Rakesh Kumar Gupta, MD
• Aaron Jermaine Guzman
• H & H Family Dental, PC

• Mental Health Counselor in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.