NPIMap

Organization Active NPI

Wellness Loft Inc.

  • Clinical Social Worker
  • Effingham, IL
National Provider Identifier
1689926487
Registry record updated Jan 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149011337 Issued in IL
Legal business name
WELLNESS LOFT INC.
Practice address
408 South 4TH St.
Effingham, IL 62401
Phone
(217) 347-5118
Fax
(217) 347-7609
NPI assigned
Oct 4, 2012
Last updated
Jan 28, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2013

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

Authorized official

Name
Mrs. Amy M Guy, MS, LCPC
Title
Director
Phone
(217) 347-5118

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 180.006036 IL
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 180000748 IL
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 180002037 IL
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 149011337 IL Primary

Addresses

Primary practice location

408 South 4TH St.
Effingham, IL 62401

Mailing address

408 S 4TH St
Effingham, IL 62401-3703
Phone (217) 347-5118

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130123000528 IL Part B Supplier - Clinic/Group Practice 2062665110 Receives reassigned benefits from 5 practitioners
Practice locations: Effingham, IL

National Provider Directory

National Provider Directory

Locations

408 S 4th St
Effingham, IL 62401
Phone (217) 246-1810

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1349308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359331200000",
    "number": "1689926487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 S 4TH ST",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624013703",
            "telephone_number": "217-347-5118",
            "fax_number": "217-347-7609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 SOUTH 4TH ST.",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "62401",
            "telephone_number": "217-347-5118",
            "fax_number": "217-347-7609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS LOFT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-04",
        "last_updated": "2013-01-28",
        "status": "A",
        "authorized_official_last_name": "GUY",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "217-347-5118",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS, LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.006036",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180000748",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180002037",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149011337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Effingham, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; 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.