Amanda Lewis, Msw, Lcsw, Llc | |
1161 Fortune Blvd Suite 400 Shiloh IL 62269-7385 | |
(618) 334-5571 | |
Not Available |
Full Name | Amanda Lewis, Msw, Lcsw, Llc |
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Speciality | Community/Behavioral Health |
Location | 1161 Fortune Blvd, Shiloh, Illinois |
Authorized Official Name and Position | Amanda Rose Lewis (MANAGING MEMBER) |
Authorized Official Contact | 6183345571 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Amanda Lewis, Msw, Lcsw, Llc 1161 Fortune Blvd Suite 400 Shiloh IL 62269-7385 Ph: (618) 334-5571 | Amanda Lewis, Msw, Lcsw, Llc 1161 Fortune Blvd Suite 400 Shiloh IL 62269-7385 Ph: (618) 334-5571 |
NPI Number | 1598110124 |
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Provider Enumeration Date | 05/02/2016 |
Last Update Date | 05/02/2016 |
Medicare PECOS PAC ID | 9133411986 |
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Medicare Enrollment ID | O20160714001602 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598110124 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 149.018245 (Illinois) | Primary |
Provider Name | Amanda R Lewis |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1518360171 PECOS PAC ID: 8123318847 Enrollment ID: I20160608000397 |
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