| Coping With Choices Therapy Group Llc | |
|
1151 Boulder Creek Drive Apt 104 O Fallon IL 62269-0079 | |
| (618) 825-8173 | |
| Not Available |
| Full Name | Coping With Choices Therapy Group Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1151 Boulder Creek Drive, O Fallon, Illinois |
| Authorized Official Name and Position | Yvonne Suzette Gates (PRESIDENT) |
| Authorized Official Contact | 6188258173 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coping With Choices Therapy Group Llc 4020 Green Mount Crossing Dr Ste 108 O Fallon IL 62269-7287 Ph: (618) 825-8173 | Coping With Choices Therapy Group Llc 1151 Boulder Creek Drive Apt 104 O Fallon IL 62269-0079 Ph: (618) 825-8173 |
| NPI Number | 1104419365 |
|---|---|
| Provider Enumeration Date | 02/18/2021 |
| Last Update Date | 02/18/2021 |
| Certification Date | 01/28/2021 |
| Medicare PECOS PAC ID | 6406257401 |
|---|---|
| Medicare Enrollment ID | O20210629000282 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104419365 | NPI | - | NPPES |
| Provider Name | Tyree E Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720297989 PECOS PAC ID: 6305062209 Enrollment ID: I20140730001062 |
| Provider Name | Angela M Bryant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942504105 PECOS PAC ID: 1951702968 Enrollment ID: I20210629000561 |
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