Cedar Hollow – Credentialing
Provider enrollment tracking across the three Cedar Hollow groups
| Provider name | Group | Credential | Provider NPI | CAQH # | State licensure | License status | License expires | Payer | Status | Application ID | Submitted | SSN |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Maya Chen | Evanston | LCSW | 1628194821 | 20491019 | IL LCSW 149.031882 | Active | 11/30/2027 | Larkspur Health Plan | Ready to submit | Restricted | ||
| Noah Brooks | Evanston | LCPC | 1993518190 | 20498938 | IL LCPC 180.014472 | Active | 03/31/2027 | Larkspur Health Plan | Ready to submit | Restricted | ||
| Taylor Reed | Evanston | LCPC | 1937865797 | 20506857 | IL LCPC 180.012906 | Expired | 09/30/2026 | Larkspur Health Plan | On hold | Restricted | ||
| Jessie Albright | Evanston | LCSW | 1543231948 | 20514776 | IL LCSW 149.027719 | Active | 11/30/2027 | Larkspur Health Plan | Ready to submit | Restricted | ||
| Daniel Ortiz | Evanston | LCSW | 1757491186 | 20522695 | IL LCSW 149.030051; WI 12044-123 | Active | 11/30/2027 | Larkspur Health Plan | Ready to submit | Restricted | ||
| Priya Natarajan | Oak Park | PsyD | 1252760189 | 20530614 | IL Psychologist 071.009318 | Active | 09/30/2028 | Larkspur Health Plan | Ready to submit | Restricted | ||
| Samuel Okafor | Oak Park | LMFT | 1555979711 | 20538533 | IL LMFT 142.004417 | Active | 06/30/2027 | Larkspur Health Plan | Ready to submit | Restricted | ||
| Grace Lindqvist | Oak Park | LCSW | 1507529170 | 20546452 | IL LCSW 149.033104 | Active | 11/30/2027 | Larkspur Health Plan | Ready to submit | Restricted |
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