Patricia a. Roosevelt LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.011395 Issued in IL

Legal business name

PATRICIA A. ROOSEVELT LLC

Doing business as

Dare to Hope Counseling

Practice address

101 McCrosky Professional Park
Columbia, IL 62236-2471

Phone

(618) 977-0734

NPI assigned

Jun 8, 2018

Last updated

Jun 8, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Patricia A. Roosevelt, LCPCNPI 1679096648

Title

President

Phone

(618) 977-0734

Specialties & licenses 1

Addresses

Other names 1

• Dare to Hope Counseling Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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.

• Patricia A. Roosevelt, LPC

  • Professional Counselor
  • Saint Louis, MO
  • NPI 1679096648

  IL

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528416000000",
    "number": "1891288478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4604 KASKASKIA RD",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622983712",
            "telephone_number": "618-977-0734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MCCROSKY PROFESSIONAL PARK",
            "city": "COLUMBIA",
            "state": "IL",
            "postal_code": "622362471",
            "telephone_number": "618-977-0734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRICIA A. ROOSEVELT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-08",
        "last_updated": "2018-06-08",
        "status": "A",
        "authorized_official_last_name": "ROOSEVELT",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-977-0734",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.011395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dare to Hope Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; 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.