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MAITRI PATH TO WELLNESS PLLC
NPI 1184204950
Social Worker - Clinical in Peru, IL

Active since April 14, 2021
710 PEORIA ST, PERU, IL 61354(815) 780-0690(815) 410-1937 Get Directions Write a Review

NPPES record last updated: April 19, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Apr 19, 2024, Jul 12, 2022, Apr 25, 2022 and 3 more (6 updates tracked since 2021).

About Maitri Path To Wellness Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAITRI PATH TO WELLNESS PLLC (NPI 1184204950) is a healthcare organization registered as a clinical in Peru, Illinois and active in the NPI registry since April 2021. The organization lists Brenden Fasken, Chief Operating Officer, as its authorized official.

NPPES Registry Identity

NPI1184204950
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameMAITRI PATH TO WELLNESS PLLC
Location Address710 PEORIA STPeru, IL 61354-3351
Mailing Address710 Peoria StPeru, IL 61354-3351 · (815) 780-0690 · Fax (815) 410-1937
Phone(815) 780-0690
Fax(815) 410-1937
Organization SubpartNo
Authorized OfficialBrenden FaskenChief Operating Officer · (815) 780-0690
Enumeration DateApril 14, 2021
Last NPPES UpdateApril 19, 20246 updates tracked since enumeration
NPPES CertifiedApril 19, 2024
✔ NPI 1184204950 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X
Also ListedCounselor · ProfessionalTaxonomy 101YP2500X
Also ListedSocial WorkerTaxonomy 104100000X
710 PEORIA ST, Peru, IL 61354
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Other Identifiers 2

OtherF100761217IL · Medicare
Medicaid1184204950IL

Group Practice 2

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Maitri Path To Wellness Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

5

Medicare enrollment records show 5 clinicians reassign Medicare billing to Maitri Path To Wellness PLLC, which bills Medicare for the services they deliver. Of these, 4 practice at this address. They are listed nearest first.

Clinicians, nearest first (5)

Tamara Beaber, LSW
Clinical Social Worker
NPI 1760049720
710 PEORIA ST
Peru, IL 61354
(815) 780-0690
✔ PECOS✔ Accepts MedicareSame address
Lisa Jones
Clinical Social Worker
NPI 1831692078
710 PEORIA ST
Peru, IL 61354
(815) 780-0690
✔ PECOS✔ Accepts MedicareSame address
Victoria Winterrose
Clinical Social Worker
NPI 1164988879
710 PEORIA ST
Peru, IL 61354
(815) 780-0690
✔ PECOS✔ Accepts MedicareSame address
Rachel Edgcomb, CADC
Clinical Social Worker
NPI 1629711858
710 PEORIA ST
Peru, IL 61354
(815) 780-0690
✔ PECOS✔ Accepts MedicareSame address
Stephen Christopherson, LCSW
Clinical Social Worker
NPI 1083288468
535 ELM PL STE 7
Princeton, IL 61356
(815) 872-2943
✔ PECOS✔ Accepts Medicare18 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Maitri Path To Wellness PLLC's NPI number?

The NPI number for Maitri Path To Wellness PLLC is 1184204950. It was assigned to this organization in the NPPES registry on April 14, 2021.

Where is Maitri Path To Wellness PLLC located?

Maitri Path To Wellness PLLC is located at 710 Peoria St, Peru, IL 61354. The listed phone number is (815) 780-0690.

What is Maitri Path To Wellness PLLC's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Maitri Path To Wellness PLLC enrolled in Medicare?

Yes. Maitri Path To Wellness PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Maitri Path To Wellness PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians, all in Clinical Social Worker, reassign their Medicare billing to Maitri Path To Wellness PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 4 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Maitri Path To Wellness PLLC was last updated on April 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.