| 7739956300 | |
|
1029 E 130th St Chicago IL 60628-6908 | |
| (773) 995-6300 | |
| (773) 995-6192 |
| Full Name | 7739956300 |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1029 E 130th St, Chicago, Illinois |
| Authorized Official Name and Position | Marquetta D Hall (BILLING CODING SPECIALIST) |
| Authorized Official Contact | 7739956300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 7739956300 1029 E.130th Street Chicago IL 60628 Ph: (773) 995-6300 | 7739956300 1029 E 130th St Chicago IL 60628-6908 Ph: (773) 995-6300 |
| NPI Number | 1336685494 |
|---|---|
| Provider Enumeration Date | 01/13/2017 |
| Last Update Date | 01/13/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336685494 | NPI | - | NPPES |
| 149018713 | Other | IL | 149018713 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149018713 (Illinois) | Primary |
Philip K Mccullough Md Sc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 E Huron St, Suite 11-100, Chicago, IL 60611 Phone: 312-695-3680 Fax: 312-926-3709 | |
Amy Lynn, Lcpc, Atr Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3020 N Lincoln Ave, Flourish Studios, Chicago, IL 60657 Phone: 773-746-7429 | |
K.a.m Alliance, Inc. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2215 W 95th St Ste 100, Chicago, IL 60643 Phone: 773-239-9600 Fax: 773-239-9601 | |
King Community Mental Health Center Corp Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4455 S King Drive, Suite 101, Chicago, IL 60653 Phone: 773-536-2700 Fax: 773-751-2250 | |
Young Adult Program Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4219 N Lincoln Ave, Chicago, IL 60618 Phone: 773-572-5500 Fax: 773-537-3488 | |
Professional Diagnostic Service, S.c. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 821 W Van Buren St, Chicago, IL 60607 Phone: 312-491-0404 Fax: 312-491-0505 | |
Universal Medical Group Ltd. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 809 E 42nd Pl, Chicago, IL 60653 Phone: 773-285-3422 |