Christopher Anthony Gresham, | |
325 Il Route 2, Dixon, IL 61021-9118 | |
(815) 284-6611 | |
Not Available |
Full Name | Christopher Anthony Gresham |
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Gender | Male |
Speciality | Counselor - Mental Health |
Location | 325 Il Route 2, Dixon, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1598249138 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Entity Name | Southpark Psychology Ltd |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1558470419 PECOS PAC ID: 8527203090 Enrollment ID: O20130404000285 |
Mailing Address | Practice Location Address |
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Christopher Anthony Gresham, 325 Il Route 2, Dixon, IL 61021-9118 Ph: (815) 284-6611 | Christopher Anthony Gresham, 325 Il Route 2, Dixon, IL 61021-9118 Ph: (815) 284-6611 |
Michelle Gonzalez, Counselor Medicare: Not Enrolled in Medicare Practice Location: 322 Depot Ave, Dixon, IL 61021 Phone: 815-288-6057 | |
Robert Lovus Dillon Ii, Counselor Medicare: Not Enrolled in Medicare Practice Location: 325 Il Route 2, Dixon, IL 61021 Phone: 815-284-9380 | |
Rae Lynn Metzler8, Counselor Medicare: Not Enrolled in Medicare Practice Location: 325 Illinois Rt 2, Dixon, IL 61021 Phone: 815-284-6611 | |
Ms. Leigh Terrell, LCPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 325 Il Route 2, Dixon, IL 61021 Phone: 815-284-6611 Fax: 815-284-6598 | |
Stephanie Marie Binkley, Counselor Medicare: Not Enrolled in Medicare Practice Location: 325 Il Route 2, Dixon, IL 61021 Phone: 815-284-6611 | |
Genevieve Gassner, Counselor Medicare: Not Enrolled in Medicare Practice Location: 325 Illinois Rt 2, Dixon, IL 61021 Phone: 815-284-6611 | |
Megan Koch, MHP Counselor Medicare: Not Enrolled in Medicare Practice Location: 325 Il Route 2, Dixon, IL 61021 Phone: 815-284-6611 |