| Edge Counseling And Wellness Llc | |
|
719 W Lake Ave Peoria IL 61614-5941 | |
| (309) 360-8912 | |
| Not Available |
| Full Name | Edge Counseling And Wellness Llc |
|---|---|
| Speciality | Social Worker |
| Location | 719 W Lake Ave, Peoria, Illinois |
| Authorized Official Name and Position | Audrey Lemasters (OWNER) |
| Authorized Official Contact | 3093608912 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edge Counseling And Wellness Llc 719 W Lake Ave Peoria IL 61614-5941 Ph: (309) 360-8912 | Edge Counseling And Wellness Llc 719 W Lake Ave Peoria IL 61614-5941 Ph: (309) 360-8912 |
| NPI Number | 1790275485 |
|---|---|
| Provider Enumeration Date | 05/17/2018 |
| Last Update Date | 11/07/2021 |
| Certification Date | 11/07/2021 |
| Medicare PECOS PAC ID | 1951659465 |
|---|---|
| Medicare Enrollment ID | O20180731002045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790275485 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Audrey A Lemasters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811058753 PECOS PAC ID: 9234264474 Enrollment ID: I20100312001016 |
| Provider Name | Devon Atkins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659062388 PECOS PAC ID: 6204289481 Enrollment ID: I20240124003892 |
| Provider Name | Ashley Mcmurtry |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982325866 PECOS PAC ID: 0446603344 Enrollment ID: I20240221003385 |
| Provider Name | Emerick Fulton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750130571 PECOS PAC ID: 7214461789 Enrollment ID: I20241107000535 |
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