NPIMap

Organization Active NPI

Goreham Incorporated

Doing business as Life Redefined Clinical Counseling

  • Social Worker
  • Wheaton, IL
National Provider Identifier
1346816402
Registry record updated Nov 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Legal business name
GOREHAM INCORPORATED
Doing business as
Life Redefined Clinical Counseling
Practice address
2150 Manchester Rd Ste 110
Wheaton, IL 60187-2474
Phone
(331) 264-5500
Fax
(331) 264-6219
NPI assigned
May 31, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2025

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

Authorized official

Name
Alexander James Goreham, LCSW, CRADC, EMDR-IINPI 1659751519
Title
Owner
Phone
(331) 264-5500

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) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X Primary

Addresses

Primary practice location

2150 Manchester Rd Ste 110
Wheaton, IL 60187-2474

Mailing address

2150 Manchester Rd Ste 110
Wheaton, IL 60187-2474
Phone (331) 264-5500

Other identifiers 1

IdentifierTypeStateIssuer
149018949MedicaidIL

Other names 1

  • Life Redefined Clinical Counseling Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240322002956 IL Part B Supplier - Clinic/Group Practice 8820435084 Receives reassigned benefits from 4 practitioners
Practice locations: Wheaton, IL

National Provider Directory

National Provider Directory

Locations

417 W Roosevelt Rd
Ste B
Wheaton, IL 60187
Phone (331) 205-8185

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1622419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1346816402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2150 MANCHESTER RD STE 110",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601872474",
            "telephone_number": "331-264-5500",
            "fax_number": "331-264-6219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 MANCHESTER RD STE 110",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601872474",
            "telephone_number": "331-264-5500",
            "fax_number": "331-264-6219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOREHAM INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-31",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "GOREHAM",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "331-264-5500",
        "authorized_official_credential": "LCSW, CRADC, EMDR-II"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149018949",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Redefined Clinical Counseling",
            "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 Nov 10, 2025; 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.