Kimberly Fawley

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

3248 Vandever Ave
Pekin, IL 61554-6257

Phone

(309) 347-5579

Fax

(309) 347-4264

NPI assigned

Aug 7, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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, 2019

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Tazwood Mental Health Center IncGroup PAC ID 1850291741, 6 clinicians

Elliott Counseling Services LLCGroup PAC ID 2264709690, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Tazwood Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pekin, IL
  • NPI 1083671127
  Medicare reassignment Care Compare group NPD
• Elliott Counseling Services, LLC

  • Community/Behavioral Health Agency
  • Normal, IL
  • NPI 1396067559
  Care Compare group
• Tazwood Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Eureka, IL
  • NPI 1134464316
  NPD

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

{
    "created_epoch": "1375833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375833600000",
    "number": "1356773717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3248 VANDEVER AVE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546257",
            "telephone_number": "309-347-5579",
            "fax_number": "309-347-4264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3248 VANDEVER AVE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546257",
            "telephone_number": "309-347-5579",
            "fax_number": "309-347-4264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAWLEY",
        "first_name": "KIMBERLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-07",
        "last_updated": "2013-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Evans
• Todd Richard Faga
• Mariah Faivre, M.S.
• Nishath Farooqui, PHARM D
• James William Farrell, M.D.
• Janelle Fenski, APN
• Kayla Ferman
• Lee Figueroa
• Melissa Finleyholmes
• Barbara J. Finnegan

• Mental Health Counselor in Pekin, IL
• Providers in Pekin, 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 Aug 7, 2013; 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.