| Blue Chair Counseling Llc | |
|
2921 Maryville Rd Ste B Maryville IL 62062-5400 | |
| (618) 920-1680 | |
| Not Available |
| Full Name | Blue Chair Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2921 Maryville Rd Ste B, Maryville, Illinois |
| Authorized Official Name and Position | Lisa M Fox (MEMBER) |
| Authorized Official Contact | 6189201680 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Chair Counseling Llc 2921 Maryville Rd Ste B Maryville IL 62062-5400 Ph: () - | Blue Chair Counseling Llc 2921 Maryville Rd Ste B Maryville IL 62062-5400 Ph: (618) 920-1680 |
| NPI Number | 1336914142 |
|---|---|
| Provider Enumeration Date | 11/21/2023 |
| Last Update Date | 11/21/2023 |
| Certification Date | 11/21/2023 |
| Medicare PECOS PAC ID | 2163964594 |
|---|---|
| Medicare Enrollment ID | O20240612003670 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336914142 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Darren J Dunahee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053749432 PECOS PAC ID: 1052548591 Enrollment ID: I20131209000963 |
| Provider Name | Lisa M Fox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184244261 PECOS PAC ID: 8022449032 Enrollment ID: I20200507000246 |
| Provider Name | Kathryn Schiber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306509120 PECOS PAC ID: 7618412388 Enrollment ID: I20240717004459 |
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