Individual provider Active NPI

Susan S Davis, LCPC

  • Mental Health Counselor
  • Wheaton, IL
National Provider Identifier
1811271679
Registry record updated Jan 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
180000861 Issued in IL
Practice address
111 N County Farm Rd
Wheaton, IL 60187-3977
Phone
(630) 682-7979
NPI assigned
Sep 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 180.000861 IL
Mental Health Counselor 101YM0800X 180000861 IL Primary

Addresses

Primary practice location

111 N County Farm Rd
Wheaton, IL 60187-3977

Mailing address

111 N County Farm Rd
Wheaton, IL 60187-3977
Phone (630) 682-7979

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240626003184 IL Practitioner - Mental Health Counselor 1355885765 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

1699 E Woodfield Rd
Suite 402
Schaumburg, IL 60173-4958
Phone (888) 428-7890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
180000861ILMDMental Health Counselor
180.000861ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Edgewood Clinical Services, P.C. Mental Health CurrentSince May 14, 2024 Accepting new patients
Psychology Specialists LTD Past Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

1616 N Damen Ave
Ste 301
Chicago, IL 60647
Phone (312) 761-4720

2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165

1699 E Woodfield Rd
Ste 402
Schaumburg, IL 60173
Phone (253) 346-0133

Organizations & group practices 2

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": "1317168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737763200000",
    "number": "1811271679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N COUNTY FARM RD",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601873977",
            "telephone_number": "630-682-7979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N COUNTY FARM RD",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601873977",
            "telephone_number": "630-682-7979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "SUSAN",
        "middle_name": "S",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-28",
        "last_updated": "2025-01-25",
        "certification_date": "2025-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.000861",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180000861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheaton, IL

Sources for this page

Verify at the official NPI Registry.