Healthcare Provider Details

I. General information

NPI: 1407765241
Provider Name (Legal Business Name): BETH VOGEL INTEGRATIVE PSYCHOTHERAPY & MENTAL WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 DEGARMO DR
BLOOMINGTON IL
61704-9101
US

IV. Provider business mailing address

2810 DEGARMO DR
BLOOMINGTON IL
61704-9101
US

V. Phone/Fax

Practice location:
  • Phone: 309-310-6465
  • Fax:
Mailing address:
  • Phone: 309-310-6465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. BETH ANNE VOGEL
Title or Position: OWNER/MANAGING MEMBER
Credential: LCSW
Phone: 309-310-6465