| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1510 W Ottawa Rd, Paxton, Illinois |
| Authorized Official Name and Position | Laurelyn Cropek (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2173794302 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1510 W Ottawa Rd Po Box 162 Paxton IL 60957 Ph: (217) 379-4302 | 1510 W Ottawa Rd Paxton IL 60957 Ph: (217) 379-4302 |
| NPI Number | 1972567261 |
|---|---|
| Provider Enumeration Date | 04/13/2006 |
| Last Update Date | 11/29/2022 |
| Certification Date | 11/29/2022 |
| Medicare PECOS PAC ID | 6608861174 |
|---|---|
| Medicare Enrollment ID | O20040415000893 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972567261 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kenneth G Gilbert |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225190242 PECOS PAC ID: 0749252930 Enrollment ID: I20040809000797 |
| Provider Name | Laurelyn Cropek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922010701 PECOS PAC ID: 8820083397 Enrollment ID: I20070720000823 |
| Provider Name | Kristen Speagle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952809741 PECOS PAC ID: 4880062355 Enrollment ID: I20221115002024 |
| Provider Name | Jeffrey C Reynolds |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477641165 PECOS PAC ID: 5496198269 Enrollment ID: I20240208002099 |
| Provider Name | Lynn Marie Mathews |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750530135 PECOS PAC ID: 7810074242 Enrollment ID: I20240208002383 |
| Provider Name | Jillian Kelly Schlomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427671890 PECOS PAC ID: 0941645071 Enrollment ID: I20240228004353 |
| Provider Name | Kyle Jane Kroha |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376296020 PECOS PAC ID: 4789116948 Enrollment ID: I20241014002538 |
Community Resource And Counseling Center Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1510 W Ottawa Rd, Paxton, IL 60957 Phone: 217-379-4302 Fax: 217-817-0379 |