NPIMap

Organization Active NPI

Kristin Padera Ma LCPC Inc.

Doing business as Kristin Padera & Associates

  • Mental Health Counselor
  • Wheaton, IL
National Provider Identifier
1174047138
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
180.010302 Issued in IL
Legal business name
KRISTIN PADERA MA LCPC INC.
Doing business as
Kristin Padera & Associates
Padera Therapy and Wellness
Practice address
1131 Wheaton Oaks CT
Wheaton, IL 60187-3181
Phone
(630) 940-6828
NPI assigned
Aug 1, 2017
Last updated
Dec 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2022

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

Authorized official

Name
Kristin Georgianne Padera, MA LCPCNPI 1114323359
Title
Ceo
Phone
(630) 940-9628

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 180.010302 IL
Mental Health Counselor 101YM0800X NU
Mental Health Counselor 101YM0800X 180.010302 IL Primary

Addresses

Primary practice location

1131 Wheaton Oaks CT
Wheaton, IL 60187-3181

Mailing address

1131 Wheaton Oaks CT
Wheaton, IL 60187-3181
Phone (630) 940-6828

Other identifiers 7

IdentifierTypeStateIssuer
1700501962MedicaidIL
1962127019MedicaidIL
1023550282MedicaidIL
1114323359MedicaidIL
1902404650MedicaidIL
1932685732MedicaidIL
1528795739MedicaidIL

Other names 2

  • Kristin Padera & Associates Doing business as
  • Padera Therapy and Wellness Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.simplepractice.com Direct

National Provider Directory

National Provider Directory

Locations

503 Thornhill Dr
Ste B
Carol Stream, IL 60188

1131 Wheaton Oaks Ct
Wheaton, IL 60187
Phone (630) 940-6828

2100 Manchester Rd
Ste 1420
Wheaton, IL 60187
Phone (630) 940-6828

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1501545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670198400000",
    "number": "1174047138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 WHEATON OAKS CT",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601873181",
            "telephone_number": "630-940-6828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1131 WHEATON OAKS CT",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601873181",
            "telephone_number": "630-940-6828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRISTIN PADERA MA LCPC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-01",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A",
        "authorized_official_last_name": "PADERA",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "GEORGIANNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "630-940-9628",
        "authorized_official_credential": "MA LCPC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "180.010302",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.010302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700501962",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962127019",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023550282",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114323359",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902404650",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932685732",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528795739",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.simplepractice.com",
            "affiliation": "N",
            "endpointDescription": "EMR System",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EMR",
            "address_1": "1131 Wheaton Oaks Ct",
            "city": "Wheaton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601873181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kristin Padera & Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Padera Therapy and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wheaton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.