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NATHANIEL OLDENBURG LCPC
NPI 1790431880
Counselor - Professional in Peoria, IL

Active since February 27, 2022Opted out of Medicare · through Jan 31, 2028
7210 N VILLA LAKE DR STE C, PEORIA, IL 61614(309) 713-1485 Get Directions Write a Review

NPPES record last updated: February 27, 2022. Verified against the NPPES registry weekly; last sync: October 04, 2026.

About Nathaniel Oldenburg Lcpc NPPES

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

NATHANIEL OLDENBURG LCPC (NPI 1790431880) is an individual professional provider in Peoria, Illinois, licensed in Illinois (180012347) and active in the NPI registry since February 2022. He has opted out of Medicare through January 31, 2028.

NPPES Registry Identity

NPI1790431880
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameNATHANIEL OLDENBURGCredential: LCPC
Location Address7210 N VILLA LAKE DR STE CPeoria, IL 61614-8290
Mailing Address1501 Harborway DrChillicothe, IL 61523-1932 · (708) 870-8184
Phone(309) 713-1485
Sole ProprietorNo
Enumeration DateFebruary 27, 2022
NPPES CertifiedFebruary 27, 2022
✔ NPI 1790431880 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in IL · 180012347
7210 N VILLA LAKE DR STE C, Peoria, IL 61614
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Nathaniel Oldenburg Lcpc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 31, 2024 through January 31, 2028.

Opt-Out Effective DateJanuary 31, 2024
Opt-Out In Effect ThroughJanuary 31, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHELLE MATZKE MA, LCPC
Counselor (Mental Health)
7210 N VILLA LAKE DR STE C
PEORIA, IL 61614
Peoria County (309) 713-1485
KATIE NEIDETCHER LCPC
Counselor (Professional)
7210 N VILLA LAKE DR STE C
PEORIA, IL 61614
Peoria County (309) 713-1485
JULIENNE A CUMMINGS LCSW, RN
Social Worker (Clinical)
7210 N VILLA LAKE DR STE C
PEORIA, IL 61614
Peoria County (309) 713-1485
GRETA LONG
Counselor (Professional)
7210 N VILLA LAKE DR STE C
PEORIA, IL 61614
Peoria County (309) 798-4962
MRS. RACHEL VICTORIA LAMPE MA, LPC
Counselor
7210 N VILLA LAKE DR STE C
PEORIA, IL 61614
Peoria County (309) 713-1485
HANNAH DOBSON MA,AMFT, QMHP
Marriage & Family Therapist
7210 N VILLA LAKE DR STE C
PEORIA, IL 61614
Peoria County (309) 713-1485
SHELLY HART MA, LCP
Counselor (Mental Health)
7210 N VILLA LAKE DR STE C
PEORIA, IL 61614
Peoria County (309) 713-1485
SUMMIT FAMILY THERAPY PLLC
Counselor (Professional)
7210 N VILLA LAKE DR STE C
PEORIA, IL 61614
Peoria County (309) 713-1485

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 Nathaniel Oldenburg's NPI number?

The NPI number for Nathaniel Oldenburg is 1790431880. It was assigned to this individual provider in the NPPES registry on February 27, 2022.

Where is Nathaniel Oldenburg located?

Nathaniel Oldenburg practices at 7210 N Villa Lake Dr Ste C, Peoria, IL 61614. The listed phone number is (309) 713-1485.

What is Nathaniel Oldenburg's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Nathaniel Oldenburg enrolled in Medicare?

No. Nathaniel Oldenburg has opted out of Medicare through January 31, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Nathaniel Oldenburg was last updated on February 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.