NPIMap

Organization Active NPI

Family Life Consultants, Inc

  • Psychologist
  • Collinsville, IL
National Provider Identifier
1164532248
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
FAMILY LIFE CONSULTANTS, INC
Practice address
2014 Vandalia
Collinsville, IL 62234
Phone
(618) 345-9536
Fax
(618) 345-9587
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Sandra J Becker-Warden, LCSWNPI 1205935350
Title
President
Phone
(618) 345-9536

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
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

2014 Vandalia
Collinsville, IL 62234

Mailing address

2014 Vandalia
Collinsville, IL 62234
Phone (618) 345-9536

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041223000152 IL Part B Supplier - Clinic/Group Practice 0840258752 Receives reassigned benefits from 2 practitioners
Practice locations: Collinsville, IL

National Provider Directory

National Provider Directory

Locations

2014 Vandalia St
Collinsville, IL 62234
Phone (618) 345-9536

Practitioners & affiliated clinicians

Practitioners 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164532248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2014 VANDALIA",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "62234",
            "telephone_number": "618-345-9536",
            "fax_number": "618-345-9587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2014 VANDALIA",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "62234",
            "telephone_number": "618-345-9536",
            "fax_number": "618-345-9587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY LIFE CONSULTANTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BECKER-WARDEN",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-345-9536",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Collinsville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.