Renata Shante Caldwell, LCPC, LSOTP

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.015603 Issued in IL

Practice address

2900 Frank Scott Pkwy W Ste 950
Belleville, IL 62223-5010

Phone

(618) 233-3205

Fax

(618) 233-1407

NPI assigned

Nov 6, 2023

Last updated

Apr 26, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern Illinois Healthcare Foundation Inc

  dba Centreville Health Center

  • Federally Qualified Health Center (FQHC)
  • Centreville, IL
  • NPI 1609813500
  NPD
• Southern Illinois Healthcare Foundation Inc

  dba SIHF Healthcare

  • Federally Qualified Health Center (FQHC)
  • Waterloo, IL
  • NPI 1821813247
  NPD

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

{
    "created_epoch": "1699228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714089600000",
    "number": "1639942220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 FRANK SCOTT PKWY W STE 950",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622235010",
            "telephone_number": "618-233-3205",
            "fax_number": "618-233-1407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 FRANK SCOTT PKWY W STE 950",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622235010",
            "telephone_number": "618-233-3205",
            "fax_number": "618-233-1407"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16 Emerald Ter",
            "address_purpose": "LOCATION",
            "city": "Swansea",
            "state": "IL",
            "postal_code": "622262321",
            "country_code": "US",
            "telephone_number": "618-974-2591",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CALDWELL",
        "first_name": "RENATA",
        "middle_name": "SHANTE",
        "name_prefix": "Ms.",
        "credential": "LCPC, LSOTP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-06",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "270.000208",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.015603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• C2D, LLC (Care2Day Express Care)
• Ca Group LLC
• Ca Group LLC
• Ca Group, LLC
• Ca Group, LLC
• Anthony Cali
• Camelot Care Centers (Clarvida)
• Jessica Cameron, OTR
• Alice Kenale Campbell, LPN
• Courtney Anne Cannes, LCPC

• Professional Counselor in Belleville, IL
• Providers in Belleville, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.