| Inner Mission Llc | |
|
801 E Main St St Charles IL 60174-2294 | |
| (630) 800-5207 | |
| (630) 820-0170 |
| Full Name | Inner Mission Llc |
|---|---|
| Speciality | Counselor |
| Location | 801 E Main St, St Charles, Illinois |
| Authorized Official Name and Position | Kristin A Hultgren (LCPC, OWNER) |
| Authorized Official Contact | 6308005207 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inner Mission Llc 801 E Main St St Charles IL 60174-2294 Ph: (630) 800-5207 | Inner Mission Llc 801 E Main St St Charles IL 60174-2294 Ph: (630) 800-5207 |
| NPI Number | 1609243492 |
|---|---|
| Provider Enumeration Date | 08/27/2015 |
| Last Update Date | 08/27/2015 |
| Medicare PECOS PAC ID | 9537608393 |
|---|---|
| Medicare Enrollment ID | O20240826001842 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609243492 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 180.009077 (Illinois) | Primary |
| Provider Name | Kristin Ann Hultgren |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770964074 PECOS PAC ID: 0446799209 Enrollment ID: I20240826002575 |
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