| Bauman Psychotherapy Collaborations, Llc | |
|
457 Coventry Ln Ste 115 Crystal Lake IL 60014-7571 | |
| (815) 245-4825 | |
| (815) 596-1008 |
| Full Name | Bauman Psychotherapy Collaborations, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 457 Coventry Ln Ste 115, Crystal Lake, Illinois |
| Authorized Official Name and Position | Kelly Jean Bauman (OWNER) |
| Authorized Official Contact | 8152454825 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bauman Psychotherapy Collaborations, Llc 720 S Eastwood Dr # 168 Woodstock IL 60098-4635 Ph: (815) 245-4825 | Bauman Psychotherapy Collaborations, Llc 457 Coventry Ln Ste 115 Crystal Lake IL 60014-7571 Ph: (815) 245-4825 |
| NPI Number | 1235701905 |
|---|---|
| Provider Enumeration Date | 07/13/2021 |
| Last Update Date | 11/15/2021 |
| Certification Date | 11/15/2021 |
| Medicare PECOS PAC ID | 0143610915 |
|---|---|
| Medicare Enrollment ID | O20211209002480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235701905 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kelly J Bauman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174802730 PECOS PAC ID: 3274859277 Enrollment ID: I20150311000286 |
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