| Foresight Behavioral Health Clinic Of Humboldt Park Llc | |
|
1811 W North Ave Ste 201 Chicago IL 60622-1488 | |
| (312) 414-1341 | |
| Not Available |
| Full Name | Foresight Behavioral Health Clinic Of Humboldt Park Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1811 W North Ave Ste 201, Chicago, Illinois |
| Authorized Official Name and Position | Joseph Hylak-reinholtz (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 3124141342 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Foresight Behavioral Health Clinic Of Humboldt Park Llc 303 E Wacker Dr Ste 2110 Chicago IL 60601-5312 Ph: () - | Foresight Behavioral Health Clinic Of Humboldt Park Llc 1811 W North Ave Ste 201 Chicago IL 60622-1488 Ph: (312) 414-1341 |
| NPI Number | 1568148344 |
|---|---|
| Provider Enumeration Date | 06/26/2023 |
| Last Update Date | 02/08/2024 |
| Certification Date | 02/08/2024 |
| Medicare PECOS PAC ID | 1456704899 |
|---|---|
| Medicare Enrollment ID | O20240201000991 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568148344 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Carlos P Cantu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467799908 PECOS PAC ID: 4587809934 Enrollment ID: I20140326000052 |
| Provider Name | Mary Jane G Evangelista |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720760010 PECOS PAC ID: 2163871062 Enrollment ID: I20231216000242 |
| Provider Name | Renae E Schweers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487436077 PECOS PAC ID: 8527402502 Enrollment ID: I20240217000462 |
| Provider Name | Sam K Suhail |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417571761 PECOS PAC ID: 9335583319 Enrollment ID: I20240217000505 |
| Provider Name | Emily E Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689147290 PECOS PAC ID: 4486007671 Enrollment ID: I20240220002868 |
| Provider Name | Ajibola A Obajimi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366936767 PECOS PAC ID: 1951746122 Enrollment ID: I20240227003152 |
| Provider Name | Fernanda Morales-veloz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891380077 PECOS PAC ID: 8628410800 Enrollment ID: I20240521001199 |
Philip K Mccullough Md Sc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 E Huron St, Suite 11-100, Chicago, IL 60611 Phone: 312-695-3680 Fax: 312-926-3709 | |
Amy Lynn, Lcpc, Atr Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3020 N Lincoln Ave, Flourish Studios, Chicago, IL 60657 Phone: 773-746-7429 | |
K.a.m Alliance, Inc. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2215 W 95th St Ste 100, Chicago, IL 60643 Phone: 773-239-9600 Fax: 773-239-9601 | |
King Community Mental Health Center Corp Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4455 S King Drive, Suite 101, Chicago, IL 60653 Phone: 773-536-2700 Fax: 773-751-2250 | |
Young Adult Program Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4219 N Lincoln Ave, Chicago, IL 60618 Phone: 773-572-5500 Fax: 773-537-3488 | |
Professional Diagnostic Service, S.c. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 821 W Van Buren St, Chicago, IL 60607 Phone: 312-491-0404 Fax: 312-491-0505 | |
Universal Medical Group Ltd. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 809 E 42nd Pl, Chicago, IL 60653 Phone: 773-285-3422 |