| Lantern Therapy Services, Ltd | |
|
457 Coventry Ln Ste 129a Crystal Lake IL 60014-7571 | |
| (815) 503-9018 | |
| (779) 423-0778 |
| Full Name | Lantern Therapy Services, Ltd |
|---|---|
| Speciality | Counselor |
| Location | 457 Coventry Ln Ste 129a, Crystal Lake, Illinois |
| Authorized Official Name and Position | Crisy Marie Gowan (PRESIDENT) |
| Authorized Official Contact | 8155039018 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lantern Therapy Services, Ltd 457 Coventry Ln Ste 129a Crystal Lake IL 60014-7571 Ph: (815) 503-9018 | Lantern Therapy Services, Ltd 457 Coventry Ln Ste 129a Crystal Lake IL 60014-7571 Ph: (815) 503-9018 |
| NPI Number | 1619377637 |
|---|---|
| Provider Enumeration Date | 08/27/2014 |
| Last Update Date | 08/27/2014 |
| Medicare PECOS PAC ID | 3072879006 |
|---|---|
| Medicare Enrollment ID | O20171108001274 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619377637 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 180.007379 (Illinois) | Primary |
| Provider Name | Latavia S Agada |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417338799 PECOS PAC ID: 1355636804 Enrollment ID: I20160823000339 |
| Provider Name | Alexandria Joann Hummel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487134979 PECOS PAC ID: 2264816990 Enrollment ID: I20220830002917 |
| Provider Name | Amy Tures |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891185773 PECOS PAC ID: 6002291390 Enrollment ID: I20220922003313 |
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