Anxiety And Stress Relief Center Pllc | |
110 N Main St Breese IL 62230-1630 | |
(618) 322-6424 | |
(618) 227-8227 |
Full Name | Anxiety And Stress Relief Center Pllc |
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Speciality | Social Worker |
Location | 110 N Main St, Breese, Illinois |
Authorized Official Name and Position | Christina R Diesen (OWNER/PROVIDER) |
Authorized Official Contact | 6183226424 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Anxiety And Stress Relief Center Pllc 110 N Main St Breese IL 62230-1630 Ph: (618) 322-6424 | Anxiety And Stress Relief Center Pllc 110 N Main St Breese IL 62230-1630 Ph: (618) 322-6424 |
NPI Number | 1619686417 |
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Provider Enumeration Date | 11/21/2022 |
Last Update Date | 01/11/2024 |
Certification Date | 01/11/2024 |
Medicare PECOS PAC ID | 7012350739 |
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Medicare Enrollment ID | O20240209002480 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619686417 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Christina R Diesen |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1326161969 PECOS PAC ID: 6406952472 Enrollment ID: I20240209002543 |
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Christina R. Diesen, Lcsw Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 N Main St, Breese, IL 62230 Phone: 618-322-6424 Fax: 618-227-8227 |