| Bethesda Behavioral Health Services Llc | |
|
1337 W 73rd St Chicago IL 60636-4101 | |
| (773) 817-1168 | |
| Not Available |
| Full Name | Bethesda Behavioral Health Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 1337 W 73rd St, Chicago, Illinois |
| Authorized Official Name and Position | Nicole Lucy Thompson (CEO) |
| Authorized Official Contact | 7738171168 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bethesda Behavioral Health Services Llc 1337 W 73rd St Chicago IL 60636-4101 Ph: (773) 817-1168 | Bethesda Behavioral Health Services Llc 1337 W 73rd St Chicago IL 60636-4101 Ph: (773) 817-1168 |
| NPI Number | 1871190512 |
|---|---|
| Provider Enumeration Date | 10/06/2020 |
| Last Update Date | 04/12/2024 |
| Certification Date | 04/12/2024 |
| Medicare PECOS PAC ID | 4688015753 |
|---|---|
| Medicare Enrollment ID | O20240508000101 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871190512 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Nicole Thompson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134576523 PECOS PAC ID: 4385085455 Enrollment ID: I20240508000215 |
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