| Grit And Grace Therapy Pllc | |
|
1204 E Oak St Ste 2-2 Mahomet IL 61853-2795 | |
| (217) 530-6708 | |
| Not Available |
| Full Name | Grit And Grace Therapy Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 1204 E Oak St Ste 2-2, Mahomet, Illinois |
| Authorized Official Name and Position | Jessica L Mcclellan (OWNER) |
| Authorized Official Contact | 2175305608 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grit And Grace Therapy Pllc 1204 E Oak St Ste 2-2 Mahomet IL 61853-2795 Ph: (217) 530-6708 | Grit And Grace Therapy Pllc 1204 E Oak St Ste 2-2 Mahomet IL 61853-2795 Ph: (217) 530-6708 |
| NPI Number | 1013666015 |
|---|---|
| Provider Enumeration Date | 03/18/2022 |
| Last Update Date | 03/18/2022 |
| Certification Date | 03/18/2022 |
| Medicare PECOS PAC ID | 2062889371 |
|---|---|
| Medicare Enrollment ID | O20221028002667 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013666015 | NPI | - | NPPES |
| 1487209359 | Other | INDIVIDUAL NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Joellen Juenger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578970505 PECOS PAC ID: 9436371911 Enrollment ID: I20141118001389 |
| Provider Name | Jessica L Mcclellan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487209359 PECOS PAC ID: 9234467051 Enrollment ID: I20190819000101 |
| Provider Name | Natasha Nichole Nuss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154627172 PECOS PAC ID: 3678985512 Enrollment ID: I20201217000057 |
| Provider Name | Daniel Thomas Foutch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669149134 PECOS PAC ID: 4880084607 Enrollment ID: I20211209000207 |
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