Phetsavanh Coggin, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180010325 Issued in IL

Practice address

3701 Doty Rd
Woodstock, IL 60098

Phone

(815) 338-6600

Fax

(815) 206-5376

NPI assigned

Jan 7, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Phetsavanh Keobouavanh Former name

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

Specialty

Mental Health Counselor

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• PCK Behavioral Health Group

  • Counselor
  • Sleepy Hollow, IL
  • NPI 1477286805
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1420588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1336537745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 KATRINA LN",
            "city": "SLEEPY HOLLOW",
            "state": "IL",
            "postal_code": "601183123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 DOTY RD",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "60098",
            "telephone_number": "815-338-6600",
            "fax_number": "815-206-5376"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10400 Haligus Rd",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429553",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-206-5376",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4201 W Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "McHenry",
            "state": "IL",
            "postal_code": "600508409",
            "country_code": "US",
            "telephone_number": "815-338-6600",
            "fax_number": "815-206-5376",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COGGIN",
        "first_name": "PHETSAVANH",
        "name_prefix": "Mrs.",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-07",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180010325",
            "primary": true
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "IL",
            "license": "1001080",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHETSAVANH",
            "last_name": "KEOBOUAVANH",
            "credential": "LCPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kirk H Christensen, DDS
• Sarah Christensen
• Ericka Christiansen, LCSW
• Dawn Maureen Tan Clam, PT
• Sarah Elizabeth Clark, LPC
• Community Chiropractic Center Woodstock SC
• Community Clinic Center, LTD
• Community Counseling Center, LTD.
• Community Health Partnership of Illinois
• Timothy D Conway, DDS

• Mental Health Counselor in Woodstock, IL
• Providers in Woodstock, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.