William Tiva Bounthong, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149025844 Issued in IL

Practice address

7399 Forest Hills Rd
Loves Park, IL 61111-3974

Phone

(815) 708-7392

Fax

(815) 708-8248

NPI assigned

Jan 12, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Thrive Ally, LLC

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1205624897
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1705017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1144091505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7399 FOREST HILLS RD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611113974",
            "telephone_number": "815-708-7392",
            "fax_number": "815-708-8248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7399 FOREST HILLS RD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611113974",
            "telephone_number": "815-708-7392",
            "fax_number": "815-708-8248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUNTHONG",
        "first_name": "WILLIAM",
        "middle_name": "TIVA",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-12",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "149025844",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149025844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Josef Blake, LCSW
• Benjamin David Blitzblau, PHARMD
• Karen R Boettner, CNM, RN, MSN
• Gingerly Bolalin, P.T.
• Alexis Borodin
• Daniel S Bradt, DC
• Rita K. Bramley, RN
• Eugene E. Brander, DDS, PC
• Stanislav Brandis, M.D.
• Dana Marie Brasher, RN

• Clinical Social Worker in Loves Park, IL
• Providers in Loves Park, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.