Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicolas Gudino Jr.

Individual provider Mental Health Counselor · NPI 1063833457

Nicolas Gudino Jr. is a Mental Health Counselor in Bloomington, Illinois. Qualified in 2013, 13 years ago. Practices with Edgewood Clinical Services PC, a 292-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
13
Licensed in
IL
In the registry since
2014
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Practice location Address checks out

108 W Market St
Bloomington, IL 61701-3918
Phone: (309) 827-5351
Fax: (309) 829-6808
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence 180010615 (IL)

Record details

NPI number1063833457
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJanuary 2, 2014
Last updated in NPPESMay 26, 2022
Certification dateMay 26, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Edgewood Clinical Services P.C. — 292 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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