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15724 S Route 59 Ste 102 Plainfield IL 60544-2806 | |
| (630) 527-8877 | |
| (630) 527-8877 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 15724 S Route 59 Ste 102, Plainfield, Illinois |
| Authorized Official Name and Position | Althea R Olson (PRACTICE OWNER) |
| Authorized Official Contact | 6302441751 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15724 S Route 59 Ste 102 Plainfield IL 60544-2806 Ph: (630) 527-8877 | 15724 S Route 59 Ste 102 Plainfield IL 60544-2806 Ph: (630) 527-8877 |
| NPI Number | 1326665217 |
|---|---|
| Provider Enumeration Date | 06/26/2020 |
| Last Update Date | 12/20/2024 |
| Certification Date | 12/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326665217 | NPI | - | NPPES |
| 34096462201 | Medicaid | IL | |
| 149008446 | Medicaid | IL | |
| 32070392801 | Medicaid | IL | |
| 341463135001 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
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