NPIMap

Organization Active NPI

Alternative Wellness Therapies PLLC

  • Professional Counselor
  • Machesney Park, IL
National Provider Identifier
1144802794
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
ALTERNATIVE WELLNESS THERAPIES PLLC
Practice address
9950 N Alpine Rd Ste 103
Machesney Park, IL 61115-8362
Phone
(815) 200-6444
Fax
(815) 201-1702
NPI assigned
Apr 23, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Authorized official

Name
Marissa Ebert, LCPCNPI 1932570249
Title
Co-Owner/Therapist
Phone
(815) 200-6444

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

9950 N Alpine Rd Ste 103
Machesney Park, IL 61115-8362

Mailing address

9950 N Alpine Rd Ste 103
Machesney Park, IL 61115-8362
Phone (815) 200-6444

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.malwarebytes.com/lp/sem/en/business3.html?

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241230003257 IL Part B Supplier - Clinic/Group Practice 8628505823 Receives reassigned benefits from 3 practitioners
Practice locations: Machesney Park, IL

National Provider Directory

National Provider Directory

Locations

9950 N Alpine Rd
Machesney Park, IL 61115

Practitioners & affiliated clinicians

Practitioners 8

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": "1619136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1144802794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9950 N ALPINE RD STE 103",
            "city": "MACHESNEY PARK",
            "state": "IL",
            "postal_code": "611158362",
            "telephone_number": "815-200-6444",
            "fax_number": "815-201-1702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9950 N ALPINE RD STE 103",
            "city": "MACHESNEY PARK",
            "state": "IL",
            "postal_code": "611158362",
            "telephone_number": "815-200-6444",
            "fax_number": "815-201-1702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTERNATIVE WELLNESS THERAPIES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-23",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "EBERT",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "CO-OWNER/THERAPIST",
        "authorized_official_telephone_number": "815-200-6444",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.malwarebytes.com/lp/sem/en/business3.html?",
            "affiliation": "N",
            "address_1": "9950 N Alpine Rd Ste 103",
            "city": "Machesney Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "611158362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Machesney Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; 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.