Yvonne Licavoli

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

178015261 Issued in IL

Practice address

4509 N Illinois St Ste 4
Swansea, IL 62226-1524

Phone

(314) 669-5060

NPI assigned

Jun 17, 2022

Sex

Female

Sole proprietor

Yes

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

Accepts the Medicare-approved amount as payment in full

Group practices

Optimum Mental Health HealingGroup PAC ID 5698144608, 4 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.

• Optimum Mental Health Healing

  • Psychiatric/Mental Health Nurse Practitioner
  • Swansea, IL
  • NPI 1265179477

  IL

  Medicare reassignment Care Compare group NPD
• Amaryllis Mind, Body, & Soul Counseling

  • Mental Health Counselor
  • Swansea, IL
  • NPI 1083496285
  NPD Authorized official

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

{
    "created_epoch": "1655424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1760113005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9626 RIDGE HEIGHTS RD",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082319",
            "telephone_number": "314-397-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4509 N ILLINOIS ST STE 4",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622261524",
            "telephone_number": "314-669-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICAVOLI",
        "first_name": "YVONNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-17",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178015261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori A Lehr-Knapp, LCPC
• Bonnie Jo Leveling, MA CCC/SLP
• Morton A Levy, MD
• Brioncca Lewis, RN
• Rasheeda Lewis
• Lifespine Center Inc.
• Kim Littlefield
• Live More Life LLC
• Libby Locke
• Cheryl Lynn Logston, LCSW

• All providers in Swansea, IL
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; 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.