| Elisa M Duncan Llc | |
|
1117 N Jackson St Bloomington IN 47404-3385 | |
| (812) 322-3467 | |
| Not Available |
| Full Name | Elisa M Duncan Llc |
|---|---|
| Speciality | Counselor |
| Location | 1117 N Jackson St, Bloomington, Indiana |
| Authorized Official Name and Position | Elisa Duncan (OWNER / OPERATOR) |
| Authorized Official Contact | 8123223467 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elisa M Duncan Llc 1117 N Jackson St Bloomington IN 47404-3385 Ph: (812) 322-3467 | Elisa M Duncan Llc 1117 N Jackson St Bloomington IN 47404-3385 Ph: (812) 322-3467 |
| NPI Number | 1629846241 |
|---|---|
| Provider Enumeration Date | 12/13/2023 |
| Last Update Date | 12/13/2023 |
| Certification Date | 12/13/2023 |
| Medicare PECOS PAC ID | 3274973557 |
|---|---|
| Medicare Enrollment ID | O20240503000821 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629846241 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Elisa Marie Duncan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396949103 PECOS PAC ID: 4183064462 Enrollment ID: I20240503000924 |
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