Grief River, Llc | |
800 Spring St Ste 101 Galena IL 61036-2003 | |
(773) 454-9176 | |
Not Available |
Full Name | Grief River, Llc |
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Speciality | Counselor |
Location | 800 Spring St Ste 101, Galena, Illinois |
Authorized Official Name and Position | Thomas John Dennis (OWNER) |
Authorized Official Contact | 7734549176 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Grief River, Llc 1 Cayuga Trl Galena IL 61036-9430 Ph: (773) 454-9176 | Grief River, Llc 800 Spring St Ste 101 Galena IL 61036-2003 Ph: (773) 454-9176 |
NPI Number | 1093582306 |
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Provider Enumeration Date | 12/06/2023 |
Last Update Date | 12/07/2023 |
Certification Date | 12/07/2023 |
Medicare PECOS PAC ID | 6709222771 |
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Medicare Enrollment ID | O20240313000244 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093582306 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Provider Name | Thomas John Dennis |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1285800318 PECOS PAC ID: 0042669988 Enrollment ID: I20240109003206 |
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