| Back To Basics Counseling, Llc | |
|
106 N Main St Decatur IL 62523-1207 | |
| (217) 821-8269 | |
| Not Available |
| Full Name | Back To Basics Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 106 N Main St, Decatur, Illinois |
| Authorized Official Name and Position | Jaymie L Mccammon (LCSW) |
| Authorized Official Contact | 7792200441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Back To Basics Counseling, Llc 106 N Main St Decatur IL 62523-1207 Ph: (779) 220-0441 | Back To Basics Counseling, Llc 106 N Main St Decatur IL 62523-1207 Ph: (217) 821-8269 |
| NPI Number | 1437773579 |
|---|---|
| Provider Enumeration Date | 06/04/2020 |
| Last Update Date | 07/17/2020 |
| Certification Date | 07/17/2020 |
| Medicare PECOS PAC ID | 7113337585 |
|---|---|
| Medicare Enrollment ID | O20201113002097 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437773579 | NPI | - | NPPES |
| 1194099853 | Other | IL | NPI 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jaymie L Mccammon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194099853 PECOS PAC ID: 6901043876 Enrollment ID: I20130513000579 |
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