| Beacon Of Enlightenment | |
|
6072 Brynwood Dr Ste 201 Rockford IL 61114-5829 | |
| (815) 564-8633 | |
| (779) 423-0778 |
| Full Name | Beacon Of Enlightenment |
|---|---|
| Speciality | Counselor |
| Location | 6072 Brynwood Dr Ste 201, Rockford, Illinois |
| Authorized Official Name and Position | Crisy Gowan (OWNER) |
| Authorized Official Contact | 8155648633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Of Enlightenment 6072 Brynwood Dr Ste 201 Rockford IL 61114-5829 Ph: (815) 564-8633 | Beacon Of Enlightenment 6072 Brynwood Dr Ste 201 Rockford IL 61114-5829 Ph: (815) 564-8633 |
| NPI Number | 1376200550 |
|---|---|
| Provider Enumeration Date | 11/22/2021 |
| Last Update Date | 11/29/2021 |
| Certification Date | 11/29/2021 |
| Medicare PECOS PAC ID | 1759776404 |
|---|---|
| Medicare Enrollment ID | O20220316003456 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376200550 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Latavia S Agada |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417338799 PECOS PAC ID: 1355636804 Enrollment ID: I20160823000339 |
| Provider Name | Alexandria Joann Hummel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487134979 PECOS PAC ID: 2264816990 Enrollment ID: I20220830002917 |
| Provider Name | Amy Tures |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891185773 PECOS PAC ID: 6002291390 Enrollment ID: I20220922003313 |
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