Individual provider Active NPI

Ingo Weigold, LPC

  • Mental Health Counselor
  • St Charles, IL
National Provider Identifier
1174124747
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
178016501 Issued in IL
Practice address
1120 E Main St Ste 201
St Charles, IL 60174-2287
Phone
(630) 377-6613
Fax
(630) 377-6225
NPI assigned
Nov 2, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Mental Health Counselor 101YM0800X 178016501 IL Primary

Addresses

Primary practice location

1120 E Main St Ste 201
St Charles, IL 60174-2287

Mailing address

1120 E Main St Ste 201
St Charles, IL 60174-2287
Phone (630) 377-6613

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240124002678 IL Practitioner - Mental Health Counselor 1951754191 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centennial Counseling Center, PCGroup PAC ID 7416959390, 26 clinicians

Practice addresses (Care Compare)

1120 E Main St
Suite 201
St Charles, IL 60174-2287
Phone (630) 377-6613

30 S Shumway Ave
Suite 2W
Batavia, IL 60510-1999
Phone (630) 379-7673

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
178016501ILMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Soulshine Counseling PLLC Mental Health CurrentSince Mar 3, 2026 Accepting new patients
Centennial Counseling Center, PC Mental Health CurrentSince Jan 1, 2024 Accepting new patients

Locations

30 S Shumway Ave
Ste 2W
Batavia, IL 60510
Phone (630) 379-7673

1120 E Main St
Ste 201
St Charles, IL 60174
Phone (630) 377-6613

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1604275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1174124747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 E MAIN ST STE 201",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742287",
            "telephone_number": "630-377-6613",
            "fax_number": "630-377-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 E MAIN ST STE 201",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742287",
            "telephone_number": "630-377-6613",
            "fax_number": "630-377-6225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIGOLD",
        "first_name": "INGO",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-02",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178016501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Charles, IL

Sources for this page

Verify at the official NPI Registry.