NPIMap

Organization Active NPI

Live Well Counseling Services

  • Clinical Social Worker
  • Venedy, IL
National Provider Identifier
1881055838
Registry record updated Apr 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.017552 Issued in IL
Legal business name
LIVE WELL COUNSELING SERVICES
Practice address
13317 County Highway 12
Venedy, IL 62214-1103
Phone
(618) 317-1537
NPI assigned
Mar 17, 2016
Last updated
Apr 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2020

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

Authorized official

Name
Bethany Raye Borrenpohl, LCSWNPI 1861860124
Title
Owner
Phone
(618) 317-1537

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.017552 IL Primary

Addresses

Primary practice location

13317 County Highway 12
Venedy, IL 62214-1103

Mailing address

13317 County Highway 12
Venedy, IL 62214-1103
Phone (618) 317-1537

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160329002203 IL Part B Supplier - Clinic/Group Practice 5991002420 Receives reassigned benefits from 14 practitioners
O20200507001567 MO Part B Supplier - Clinic/Group Practice 5991002420 Receives reassigned benefits from 2 practitioners
Practice locations: Warrensburg, MO; Saint Louis, MO; Saint Charles, MO

National Provider Directory

National Provider Directory

Locations

2900 Frank Scott Pkwy W
Ste 956
Belleville, IL 62223
Phone (618) 233-3273

1310 Mark Franklin Dr
Benton, IL 62812
Phone (618) 439-3500

491 Clinton St
Carlyle, IL 62231
Phone (618) 594-8363

253 Bradington Dr
Columbia, IL 62236
Phone (618) 218-6800

312 Mechanical Dr
East Alton, IL 62024
Phone (618) 717-0820

6277 Center Grove Rd
Edwardsville, IL 62025
Phone (618) 288-1580

408 Wilson St
Enfield, IL 62835
Phone (618) 963-2331

27 Auerbach Pl
Glen Carbon, IL 62034
Phone (618) 277-3700

2509 Frank Watson Pkwy
Highland, IL 62249
Phone (618) 530-5079

55 Ferrell Rd
Rosiclare, IL 62982
Phone (618) 285-3655

1463 Benchmark Ct
Swansea, IL 62226
Phone (618) 624-0683

800 McAdam Dr
Taylorville, IL 62568
Phone (217) 284-2277

601 N Columbia St
West Frankfort, IL 62896
Phone (618) 252-2109

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1458172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588204800000",
    "number": "1881055838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13317 COUNTY HIGHWAY 12",
            "city": "VENEDY",
            "state": "IL",
            "postal_code": "622141103",
            "telephone_number": "618-317-1537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13317 COUNTY HIGHWAY 12",
            "city": "VENEDY",
            "state": "IL",
            "postal_code": "622141103",
            "telephone_number": "618-317-1537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE WELL COUNSELING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-17",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A",
        "authorized_official_last_name": "BORRENPOHL",
        "authorized_official_first_name": "BETHANY",
        "authorized_official_middle_name": "RAYE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-317-1537",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.017552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Venedy, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; 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.