| Clay Pot Counseling, Inc. | |
|
2615 Three Oaks Rd Ste 2a Cary IL 60013-6119 | |
| (307) 752-7016 | |
| Not Available |
| Full Name | Clay Pot Counseling, Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 2615 Three Oaks Rd Ste 2a, Cary, Illinois |
| Authorized Official Name and Position | Dawn E Sopron (PRESIDENT) |
| Authorized Official Contact | 3077527016 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clay Pot Counseling, Inc. Po Box 907 Cary IL 60013-0907 Ph: (307) 752-7016 | Clay Pot Counseling, Inc. 2615 Three Oaks Rd Ste 2a Cary IL 60013-6119 Ph: (307) 752-7016 |
| NPI Number | 1164456315 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 11/15/2020 |
| Certification Date | 11/15/2020 |
| Medicare PECOS PAC ID | 0547215980 |
|---|---|
| Medicare Enrollment ID | O20201111002961 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164456315 | NPI | - | NPPES |
| 314353 | Other | WY | BLUE CROSS BLUE SHIELD |
| 396827550 | Other | IL | BCBSIL |
| F100698449 | Other | IL | MEDICARE NGS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW531 (Wyoming) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Dawn E Sopron |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932133188 PECOS PAC ID: 2264487602 Enrollment ID: I20050318000116 |
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