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5016 N University Christus Light Counseling Ste 109 Peoria IL 61614-4763 | |
| (309) 692-1220 | |
| (309) 692-1222 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 5016 N University, Peoria, Illinois |
| Authorized Official Name and Position | Candice Rae Hogden (DIRECTOR COUNSELOR) |
| Authorized Official Contact | 3096921220 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5016 N University Christus Light Counseling Ste 109 Peoria IL 61614-4763 Ph: (309) 692-1220 | 5016 N University Christus Light Counseling Ste 109 Peoria IL 61614-4763 Ph: (309) 692-1220 |
| NPI Number | 1770650442 |
|---|---|
| Provider Enumeration Date | 11/29/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770650442 | NPI | - | NPPES |
| 103515 | Other | IL | HEALTH ALLIANCE |
| 236610 | Other | IL | VALUE OPTIONS |
| 357929 | Other | IL | MHN |
| 39281200 | Medicaid | WI | |
| 469922 | Other | IL | HEALTHLINK |
| 7230084 | Other | IL | AETNA |
| 07232101 | Other | IL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | 2243-123 (Wisconsin) | Primary |
| 101Y00000X | Counselor | (Illinois) | Primary |
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