| Full Life Assessment & Therapy | |
|
4481 Ash Grove Dr Springfield IL 62711-6358 | |
| (217) 751-8995 | |
| Not Available |
| Full Name | Full Life Assessment & Therapy |
|---|---|
| Speciality | Psychologist |
| Location | 4481 Ash Grove Dr, Springfield, Illinois |
| Authorized Official Name and Position | Michael Kessler (PRESIDENT) |
| Authorized Official Contact | 2177518995 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Full Life Assessment & Therapy 3509 Carnoustie Dr Springfield IL 62712-5548 Ph: (217) 751-8995 | Full Life Assessment & Therapy 4481 Ash Grove Dr Springfield IL 62711-6358 Ph: (217) 751-8995 |
| NPI Number | 1568152189 |
|---|---|
| Provider Enumeration Date | 05/08/2023 |
| Last Update Date | 09/15/2023 |
| Certification Date | 09/15/2023 |
| Medicare PECOS PAC ID | 5395108526 |
|---|---|
| Medicare Enrollment ID | O20230905004013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568152189 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Michael J Kessler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285172205 PECOS PAC ID: 7012294275 Enrollment ID: I20170426001394 |
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