WATERFORD COUNSELING AND PSYCHOLOGICAL SERVICES, PC – Clinical Psychologist, NPI 1104250067

WATERFORD COUNSELING AND PSYCHOLOGICAL SERVICES, PC is a healthcare provider. based in Oswego, Illinois. specializing in Clinical Psychologist. The organization holds a License No. 180008137 (IL). The NPI Number for WATERFORD COUNSELING AND PSYCHOLOGICAL SERVICES, PC is 1104250067

Main info

Organization
Name
WATERFORD COUNSELING AND PSYCHOLOGICAL SERVICES, PC
NPI
1104250067
Phone
(630) 898-5322
Address
1022 Douglas Rd
Authorized Official
DR. GARY L COLEMAN CLINICAL PSYCHOLOGIST PSY.D.
Enumeration Date
28 August 2013
Last Update Date
15 December 2023
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience74
Completeness75
Years active:12State licenses:5Digital endpointsOther names

Provider Addresses for WATERFORD COUNSELING AND PSYCHOLOGICAL SERVICES, PC

  • 1022 Douglas Rd

    Oswego, IL 605435133

    Phone: (630) 898-5322

    Fax: (630) 636-6120

    Type: Location

  • 1256 WATERFORD DR

    SUITE 140

    AURORA, IL 605044510

    Phone: (630) 898-5322

    Fax: (630) 898-5324

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2013-12-19

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20131219001028OClinic/Group PracticeILTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60543)

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Reviews

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Frequently asked questions

What NPI should I save for WATERFORD COUNSELING AND PSYCHOLOGICAL SERVICES, PC?
Save NPI 1104250067 if you need a stable reference for WATERFORD COUNSELING AND PSYCHOLOGICAL SERVICES, PC.
Is WATERFORD COUNSELING AND PSYCHOLOGICAL SERVICES, PC's NPI currently valid?
The extract we use shows WATERFORD COUNSELING AND PSYCHOLOGICAL SERVICES, PC as active.
What kind of provider is WATERFORD COUNSELING AND PSYCHOLOGICAL SERVICES, PC?
The page reflects Clinical Psychologist for WATERFORD COUNSELING AND PSYCHOLOGICAL SERVICES, PC. Clinical services aligned with this taxonomy classification.
Where is WATERFORD COUNSELING AND PSYCHOLOGICAL SERVICES, PC's primary listing?
We display Oswego, Illinois because that is what the record indicates for WATERFORD COUNSELING AND PSYCHOLOGICAL SERVICES, PC.
What if Oswego, Illinois seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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