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661 W Lake St Ste 2s Chicago IL 60661-1034 | |
| (847) 323-9679 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 661 W Lake St Ste 2s, Chicago, Illinois |
| Authorized Official Name and Position | Heather Denton (OWNER) |
| Authorized Official Contact | 8473239679 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
661 W Lake St Ste 2s Chicago IL 60661-1034 Ph: (847) 323-9679 | 661 W Lake St Ste 2s Chicago IL 60661-1034 Ph: (847) 323-9679 |
| NPI Number | 1487274080 |
|---|---|
| Provider Enumeration Date | 04/23/2020 |
| Last Update Date | 12/13/2024 |
| Certification Date | 12/13/2024 |
| Medicare PECOS PAC ID | 4981138963 |
|---|---|
| Medicare Enrollment ID | O20241113002916 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487274080 | NPI | - | NPPES |
| Provider Name | Heather Jane-bates Denton |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1942334818 PECOS PAC ID: 6305370370 Enrollment ID: I20241113002653 |
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