Nathaniel Oldenburg, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180012347 Issued in IL

Practice address

7210 N Villa Lake Dr Ste C
Peoria, IL 61614-8290

Phone

(309) 713-1485

NPI assigned

Feb 27, 2022

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 31, 2024 through Jan 31, 2028

Medicare enrollment (NPD)

Not 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.

• Summit Family Therapy PLLC

  • Professional Counselor
  • Peoria, IL
  • NPI 1548704372
  NPD

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

{
    "created_epoch": "1645920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645920000000",
    "number": "1790431880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 HARBORWAY DR",
            "city": "CHILLICOTHE",
            "state": "IL",
            "postal_code": "615231932",
            "telephone_number": "708-870-8184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7210 N VILLA LAKE DR STE C",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148290",
            "telephone_number": "309-713-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLDENBURG",
        "first_name": "NATHANIEL",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-27",
        "last_updated": "2022-02-27",
        "certification_date": "2022-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180012347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marcus Ohnemus, A.T.C.
• Oluchukwu Okonkwo, MD
• Linda Okra-Boateng
• Aderonke Beatrice Olaoye, MD
• Mutiat Olawunmi Olayiwola
• Kayla Olesky, D.O.
• Christy A. Oliphant
• Roxie N Oliver-Payne, MD
• Bradley Oliver, M.D.
• Nancy Olivero, APN

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.