THOMAS JOSEPH HENNEBERRY IV (NPI# 1386120855) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386120855 |
| Entity Type | Individual |
| Full Name | THOMAS JOSEPH HENNEBERRY IV |
| Practice Address |
8616 Northern Ave Rockford IL 61107-5309 |
| Mailing Address |
1021 N Mulford Rd Rockford IL 61107-3877 |
| Practice Telephone | 8153328003 |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2018-07-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| Street Address |
8616 NORTHERN AVE |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61107-5309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245217959 | Raymond Christopher Garcia | Psychiatry & Neurology | 8616 Northern Ave, Rockford, IL 61107-5309 | 2005-12-23 |
| 1659930956 | Margaret L Loy | Psychologist | 8616 Northern Ave, Rockford, IL 61107-5309 | 2019-06-10 |
| 1366005779 | Jacob Urbelis | Counselor | 8616 Northern Ave, Rockford, IL 61107-5309 | 2019-04-22 |
| 1679032692 | Asia E Mueller | Registered Nurse | 8616 Northern Ave, Rockford, IL 61107-5309 | 2019-03-19 |
| 1134688179 | Lori Martineau | Social Worker | 8616 Northern Ave, Rockford, IL 61107-5309 | 2019-03-19 |
| 1669931689 | Christina Renee Kelley | Registered Nurse | 8616 Northern Ave, Rockford, IL 61107-5309 | 2019-03-19 |
| 1497220388 | Jermaine E Tolefree | Counselor | 8616 Northern Ave, Rockford, IL 61107-5309 | 2018-10-08 |
| 1699253617 | Lakeysha Watkins | Counselor | 8616 Northern Ave, Rockford, IL 61107-5309 | 2018-08-01 |
| 1528546587 | Kelsey E Hayes | Counselor | 8616 Northern Ave, Rockford, IL 61107-5309 | 2018-08-01 |
| 1417435652 | Shannon Marie Ferriter | Counselor | 8616 Northern Ave, Rockford, IL 61107-5309 | 2018-07-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356952139 | Jessica Marie Tamayo Fernandez | Pharmacist | 1145 Alpine Rd, Rockford, IL 61107 | 2020-08-13 |
| 1467092379 | Unknown Safa Fatima | Student in an Organized Health Care Education/Training Program | Mercyhealth Mulford Clinic, 5970 Churchview Drive, Rockford, IL 61107 | 2020-01-08 |
| 1194367912 | Matt J Kriebs | Nurse Practitioner | 1235 N Mulford Rd Suite 103, Rockford, IL 61107 | 2019-10-14 |
| 1265962336 | Mary Golembeck | Nurse Practitioner | 7290 Argus Dr, Rockford, IL 61107 | 2017-06-12 |
| 1831644749 | Tessa Lee | Occupational Therapist | 3422 Lauderdale Ln, Rockford, IL 61107 | 2016-08-20 |
| 1942626965 | Elevated Health Essentials, LLC | Chiropractor | 124 N Water St Ste 204e, Rockford, IL 61107 | 2014-03-14 |
| 1093139909 | Swedishamerican Hospital | Surgery | 1639 N Alpine Rd Ste 400, Rockford, IL 61107 | 2014-02-12 |
| 1346676582 | Christopher Anthony Ziganto | Pharmacist | 494 Bienterra Trail #2, Rockford, IL 61107 | 2013-09-19 |
| 1023358272 | Lavanya Durairajan | Physical Therapist | 7358 Shiligton Dr, Rockford, IL 61107 | 2013-02-26 |
| 1851523146 | Great Smiles of Rockford | Durable Medical Equipment & Medical Supplies | 780 N. Mulfrord Road, Rockford, IL 61107 | 2009-08-20 |
| Find all providers in zip 61107 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346866563 | Jendaya M Clark | Counselor | 1201 Cypress Ter, Rockford, IL 61102-3375 | 2020-06-23 |
| 1760045744 | Julianna Jones | Counselor | 6653 Weaver Rd Ste 115, Rockford, IL 61114 | 2019-04-16 |
| 1245706662 | Nannatte Lynne Heshelman | Counselor | 973 N Main St Apt 1, Rockford, IL 61103-7031 | 2018-10-23 |
| 1508342866 | Tiffany Williams | Counselor | 2990 N Perryville Rd Ste 2100b, Rockford, IL 61107-6814 | 2018-07-19 |
| 1487145124 | Rashanda Will | Counselor | 1903 Loomis St, Rockford, IL 61102-2665 | 2018-05-29 |
| 1922467034 | Gregory William Georgis | Counselor | 2595 N Mulford Rd, Rockford, IL 61114-5643 | 2016-02-17 |
| 1194104661 | Lutheran Social Services of Illinois | Counselor | 402 Kishwaukee St, Ste 101, Rockford, IL 61104-2041 | 2015-05-29 |
| 1073936068 | Jordan Bont | Counselor | 8 E Bridge St, Suite E1, Rockford, MI 49341-1601 | 2014-01-27 |
| 1730736141 | Al Despertar Counseling and Guidance Services, LLC | Counselor | 7674 Northland Dr Ne, Rockford, MI 49341-8804 | 2019-08-20 |
| 1033763446 | Linda Haugen | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2019-07-25 |
| Find all providers in ROCKFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.