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27 Grant St Crystal Lake IL 60014-4372 | |
| (815) 276-3947 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 27 Grant St, Crystal Lake, Illinois |
| Authorized Official Name and Position | Dan K Blair (OWNER) |
| Authorized Official Contact | 8152763947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
27 Grant St Crystal Lake IL 60014-4372 Ph: (815) 276-3947 | 27 Grant St Crystal Lake IL 60014-4372 Ph: (815) 276-3947 |
| NPI Number | 1245479674 |
|---|---|
| Provider Enumeration Date | 02/09/2009 |
| Last Update Date | 01/14/2025 |
| Certification Date | 01/14/2025 |
| Medicare PECOS PAC ID | 9032515796 |
|---|---|
| Medicare Enrollment ID | O20210903000007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245479674 | NPI | - | NPPES |
| Provider Name | Kathleen M Deroche |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528067824 PECOS PAC ID: 9436245115 Enrollment ID: I20071010000537 |
| Provider Name | Melissa Pazen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689281073 PECOS PAC ID: 1355789009 Enrollment ID: I20240401002759 |
| Provider Name | Sheri Mueller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205230158 PECOS PAC ID: 5395186217 Enrollment ID: I20240509002056 |
| Provider Name | Dan K Blair |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891866141 PECOS PAC ID: 0941606602 Enrollment ID: I20240521001413 |
| Provider Name | Jennifer A Morano |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033750849 PECOS PAC ID: 3476095860 Enrollment ID: I20240613001177 |
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Edwin V. Gumapas M.d. Pc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 44 N Virginia St, Suite 2b, Crystal Lake, IL 60014 Phone: 815-356-0475 Fax: 815-356-0796 | |