Individual provider Active NPI

Holly Goins, MSW, LCSW

  • Clinical Social Worker
  • Peoria, IL
National Provider Identifier
1689484537
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.028220 Issued in IL
Practice address
7820 N University St Ste 204
Peoria, IL 61614-8302
Phone
(309) 863-2593
Fax
(309) 966-0861
NPI assigned
Jan 13, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.028220 IL Primary

Addresses

Primary practice location

7820 N University St Ste 204
Peoria, IL 61614-8302

Mailing address

7820 N University St Ste 204
Peoria, IL 61614-8302
Phone (309) 863-2593

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250407000011 IL Practitioner - Clinical Social Worker 8426572900 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.028220ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Wellness, LLC Clinical CurrentSince Jan 30, 2025 Accepting new patients

Locations

2020 W War Memorial Dr
Ste 304
Peoria, IL 61614
Phone (309) 689-6246

7820 N University St
Ste 204
Peoria, IL 61614
Phone (309) 589-0888

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1736726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1689484537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7820 N UNIVERSITY ST STE 204",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148302",
            "telephone_number": "309-863-2593",
            "fax_number": "309-966-0861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7820 N UNIVERSITY ST STE 204",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148302",
            "telephone_number": "309-863-2593",
            "fax_number": "309-966-0861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOINS",
        "first_name": "HOLLY",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-01-13",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.028220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.