| Blueprint | |
|
2704 Boulder Drive Suite B Urbana IL 61802 | |
| (217) 469-9300 | |
| (217) 469-9301 |
| Full Name | Blueprint |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2704 Boulder Drive, Urbana, Illinois |
| Authorized Official Name and Position | Gina K Johnson (OWNER/THERAPIST) |
| Authorized Official Contact | 2174699300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blueprint 2704 Boulder Drive Suite B Urbana IL 61802 Ph: (217) 469-9300 | Blueprint 2704 Boulder Drive Suite B Urbana IL 61802 Ph: (217) 469-9300 |
| NPI Number | 1265736110 |
|---|---|
| Provider Enumeration Date | 01/07/2011 |
| Last Update Date | 02/27/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265736110 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 180.006836 (Illinois) | Primary |
| 1041C0700X | Social Worker - Clinical | 149.009378 (Illinois) | Secondary |
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