Riverside Counseling Center PLLC

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

RIVERSIDE COUNSELING CENTER PLLC

Practice address

6653 Weaver Rd Ste 112
Rockford, IL 61114-8052

Phone

(815) 201-2687

NPI assigned

Nov 13, 2018

Organization subpart

No

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

Authorized official

Name

Kirsten Ekberg

Title

Contracting

Phone

(815) 299-1955

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• Lindsey McClanathan Doing business as
• Riverside Counseling Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lindsey McClanathan

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1073991899
  Medicare reassignment NPD
• Jamie Swenson

  • Clinical Social Worker
  • Janesville, WI
  • NPI 1689130742

  IL

  Medicare reassignment NPD
• Meredith Domanico, LPC

  • Professional Counselor
  • Rockford, IL
  • NPI 1639914781
  NPD
• Joslyn Huntsman, LCSW

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1134958341
  NPD
• Tess Knight, LPC

  • Professional Counselor
  • Rockford, IL
  • NPI 1275399727
  NPD
• Lori Poppen, LCPC

  • Professional Counselor
  • Rockford, IL
  • NPI 1417784380
  NPD
• Kelcy M Micklos

  • Marriage & Family Therapist
  • Rockford, IL
  • NPI 1649880519
  NPD (past)
• Matthew Sage, LPC

  • Professional Counselor
  • Rockford, IL
  • NPI 1912243650
  NPD (past)

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

{
    "created_epoch": "1542067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1952879546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6653 WEAVER RD STE 112",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6653 WEAVER RD STE 112",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148052",
            "telephone_number": "815-201-2687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE COUNSELING CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-13",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "EKBERG",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_title_or_position": "CONTRACTING",
        "authorized_official_telephone_number": "815-299-1955"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "311021632001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lindsey McClanathan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Riverside Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristin N. Rindt, MPAS, PA-C
• Hanna Rinkevicz
• Zachary J Rio, DPT
• River District Rehabilitation, LLC
• David A Rivera, MD
• Rizvi MD Direct
• Syed Muhammad Murtaza Zam Rizvi, MD
• RMH Pathologists, LTD
• Rna of Rockford, PLLC
• Joshua Paul Roach, D.O.

• Counselor in Rockford, IL
• Providers in Rockford, IL by specialty
• Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 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.