Ekaradhika Lila Requena

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

079124 Issued in IA

Practice address

111 10TH St SW
Waverly, IA 50677-2925

Phone

(319) 352-2064

Fax

(319) 352-2329

NPI assigned

Sep 9, 2015

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

Other names 1

• Elizabeth Victoria Requena Former name

Medicare fee-for-service enrollment

Enrolled in IA

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, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Pathways Behavioral Services IncGroup PAC ID 3779582796, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Pathways Behavioral Services Inc

  • Community/Behavioral Health Agency
  • Waverly, IA
  • NPI 1114950979
  Medicare reassignment Care Compare group NPD
• Pathways Behavioral Services Inc

  • Community/Behavioral Health Agency
  • Waterloo, IA
  • NPI 1689734451
  NPD
• Pathways Behavioral Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waterloo, IA
  • NPI 1003663907
  NPD (past)

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

{
    "created_epoch": "1441756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1619345543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 10TH ST SW",
            "city": "WAVERLY",
            "state": "IA",
            "postal_code": "506772925",
            "telephone_number": "319-352-2064",
            "fax_number": "319-352-2329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 10TH ST SW",
            "city": "WAVERLY",
            "state": "IA",
            "postal_code": "506772925",
            "telephone_number": "319-352-2064",
            "fax_number": "319-352-2329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REQUENA",
        "first_name": "EKARADHIKA",
        "middle_name": "LILA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-09",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "079124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "REQUENA",
            "middle_name": "VICTORIA",
            "credential": "LMHC, NCC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Rebecca Renze, TLMHC
• Karla Jean Reznicek, LMSW
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• Katherine Jane Marrie Ringo, LPT
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• Ron W Roelfs, OD

• Mental Health Counselor in Waverly, IA
• Providers in Waverly, IA by specialty
• Mental Health Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; 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.