|
| |
|
101 Mccrosky Professional Park Columbia IL 62236-2471 | |
| (618) 977-0734 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 101 Mccrosky Professional Park, Columbia, Illinois |
| Authorized Official Name and Position | Patricia A. Roosevelt (PRESIDENT) |
| Authorized Official Contact | 6189770734 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4604 Kaskaskia Rd Waterloo IL 62298-3712 Ph: (618) 977-0734 | 101 Mccrosky Professional Park Columbia IL 62236-2471 Ph: (618) 977-0734 |
| NPI Number | 1891288478 |
|---|---|
| Provider Enumeration Date | 06/08/2018 |
| Last Update Date | 06/08/2018 |
| Medicare PECOS PAC ID | 1850825456 |
|---|---|
| Medicare Enrollment ID | O20241105001462 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891288478 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 180.011395 (Illinois) | Primary |
| Provider Name | Patricia A. Roosevelt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679096648 PECOS PAC ID: 3577097179 Enrollment ID: I20241105001675 |
Tuning In Practices Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 276a Southwoods Ctr, Columbia, IL 62236 Phone: 618-791-0759 | |
Karen Counseling Associates Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 221 S. Metter Ave, Columbia, IL 62236 Phone: 618-281-9282 Fax: 888-972-9396 | |
Human Support Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 960 Columbia Ctr, Columbia, IL 62236 Phone: 618-939-4444 Fax: 618-939-4181 | |
Invictus Counseling Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 207 N Main St Ste 104b, Columbia, IL 62236 Phone: 314-762-1480 | |