| Life Redefined Clinical Counseling | |
|
417 W Roosevelt Rd Ste B Wheaton IL 60187-2320 | |
| (331) 205-8185 | |
| Not Available |
| Full Name | Life Redefined Clinical Counseling |
|---|---|
| Speciality | Social Worker |
| Location | 417 W Roosevelt Rd Ste B, Wheaton, Illinois |
| Authorized Official Name and Position | Alexander James Goreham (OWNER) |
| Authorized Official Contact | 3319030283 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Redefined Clinical Counseling 417 W Roosevelt Rd Ste B Wheaton IL 60187-2320 Ph: (331) 205-8185 | Life Redefined Clinical Counseling 417 W Roosevelt Rd Ste B Wheaton IL 60187-2320 Ph: (331) 205-8185 |
| NPI Number | 1346816402 |
|---|---|
| Provider Enumeration Date | 05/31/2021 |
| Last Update Date | 03/23/2022 |
| Certification Date | 03/23/2022 |
| Medicare PECOS PAC ID | 8820435084 |
|---|---|
| Medicare Enrollment ID | O20240322002956 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346816402 | NPI | - | NPPES |
| 149018949 | Medicaid | IL |
| Provider Name | Alexander Goreham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659751519 PECOS PAC ID: 3375819584 Enrollment ID: I20171016001511 |
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