NPIMap

Organization Active NPI

Revolution Counseling Services LLC

  • Clinical Social Worker
  • Davenport, IA
National Provider Identifier
1093201444
Registry record updated Jul 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
078821 Issued in IA
Legal business name
REVOLUTION COUNSELING SERVICES LLC
Practice address
601 Brady St Ste 204
Davenport, IA 52803-5251
Phone
(309) 781-4053
Fax
(309) 792-2440
NPI assigned
Jul 9, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2018

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

Authorized official

Name
Mrs. Kari Lee Stearns-Lamb, LCSW, LISWNPI 1831565290
Title
Owner/Provider
Phone
(309) 781-4053

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 078821 IA Primary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 149019131 IL

Addresses

Primary practice location

601 Brady St Ste 204
Davenport, IA 52803-5251

Mailing address

601 Brady St Ste 204
Davenport, IA 52803-5251
Phone (309) 781-4053

Other identifiers 1

IdentifierTypeStateIssuer
1831565290MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190201000634 IA Part B Supplier - Clinic/Group Practice 9133466915 Receives reassigned benefits from 2 practitioners
Practice locations: Davenport, IA
O20220221000558 IL Part B Supplier - Clinic/Group Practice 9133466915 Receives reassigned benefits from 1 practitioner
Practice locations: Moline, IL

National Provider Directory

National Provider Directory

Locations

601 Brady St
Ste 204
Davenport, IA 52803
Phone (309) 781-4053

1718 8th Ave
Unit 6
Moline, IL 61265
Phone (309) 781-4053

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531094400000",
    "number": "1093201444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 BRADY ST STE 204",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528035251",
            "telephone_number": "309-781-4053",
            "fax_number": "309-792-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 BRADY ST STE 204",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528035251",
            "telephone_number": "309-781-4053",
            "fax_number": "309-792-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION COUNSELING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-09",
        "last_updated": "2018-07-09",
        "status": "A",
        "authorized_official_last_name": "STEARNS-LAMB",
        "authorized_official_first_name": "KARI",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "309-781-4053",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW, LISW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "078821",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149019131",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831565290",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.