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

Last updated

Oct 13, 2020By the provider in NPPES

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

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• PCK Behavioral Health Group

  dba Phet C Coggin LCPC

  • 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": "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"
        },
        {
            "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"
        }
    ],
    "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.