Max Smith, | |
103 W Main St Ste 6, Oblong, IL 62449-1165 | |
(618) 636-0719 | |
Not Available |
Full Name | Max Smith |
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Gender | Male |
Speciality | Counselor - Professional |
Location | 103 W Main St Ste 6, Oblong, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1548933146 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | 180016323 (Illinois) | Primary |
101YP2500X | Counselor - Professional | 178017178 (Illinois) | Secondary |
Entity Name | Edgewood Clinical Services P.c. |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1295914646 PECOS PAC ID: 3971963901 Enrollment ID: O20230721001228 |
Entity Name | Pivot Counseling & Consulting, Ltd |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1386457026 PECOS PAC ID: 8224555842 Enrollment ID: O20250507002233 |
Mailing Address | Practice Location Address |
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Max Smith, 103 W Main St Ste 6, Oblong, IL 62449-1165 Ph: () - | Max Smith, 103 W Main St Ste 6, Oblong, IL 62449-1165 Ph: (618) 636-0719 |
Mrs. Jodi L Wiman, MA Counselor Medicare: Medicare Enrolled Practice Location: 103 W Main St, Suite 5, Oblong, IL 62449 Phone: 618-592-3116 Fax: 618-592-3117 | |
Mrs. Marcia Thorsen, LCPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 108 S Garfield St, Oblong, IL 62449 Phone: 618-769-2185 |