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2104 Windsor Pl Ste A Champaign IL 61820-7773 | |
| (217) 552-1058 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2104 Windsor Pl Ste A, Champaign, Illinois |
| Authorized Official Name and Position | Rebecca Harrison (OWNER) |
| Authorized Official Contact | 2175521058 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2104 Windsor Pl Ste A Champaign IL 61820-7773 Ph: (217) 552-1058 | 2104 Windsor Pl Ste A Champaign IL 61820-7773 Ph: (217) 552-1058 |
| NPI Number | 1033770243 |
|---|---|
| Provider Enumeration Date | 06/27/2019 |
| Last Update Date | 02/10/2023 |
| Certification Date | 02/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033770243 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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