| Life Span Counseling For Older Adults, Llc | |
|
848 W Ainslie St. Chicago IL 60640-3946 | |
| (620) 877-0498 | |
| Not Available |
| Full Name | Life Span Counseling For Older Adults, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 848 W Ainslie St., Chicago, Illinois |
| Authorized Official Name and Position | Karen Clark Elliott (PSYCHOTHERAPIST) |
| Authorized Official Contact | 6208770498 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Span Counseling For Older Adults, Llc 848 W Ainslie St. Chicago IL 60640-3946 Ph: (620) 877-0498 | Life Span Counseling For Older Adults, Llc 848 W Ainslie St. Chicago IL 60640-3946 Ph: (620) 877-0498 |
| NPI Number | 1558185892 |
|---|---|
| Provider Enumeration Date | 11/13/2024 |
| Last Update Date | 11/13/2024 |
| Certification Date | 11/13/2024 |
| Medicare PECOS PAC ID | 2365978939 |
|---|---|
| Medicare Enrollment ID | O20241205002552 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558185892 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Karen Clark Elliott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386399970 PECOS PAC ID: 8820467723 Enrollment ID: I20221216000087 |
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