| Living Waters Counseling And Consulting Services | |
|
4550 W 103rd St Ste 302b Oak Lawn IL 60453-4868 | |
| (773) 280-5675 | |
| (773) 873-5333 |
| Full Name | Living Waters Counseling And Consulting Services |
|---|---|
| Speciality | Social Worker |
| Location | 4550 W 103rd St Ste 302b, Oak Lawn, Illinois |
| Authorized Official Name and Position | Renee Lee (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7082715370 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Waters Counseling And Consulting Services 8157 S Elizabeth St Chicago IL 60620-3857 Ph: (708) 271-5370 | Living Waters Counseling And Consulting Services 4550 W 103rd St Ste 302b Oak Lawn IL 60453-4868 Ph: (773) 280-5675 |
| NPI Number | 1841899671 |
|---|---|
| Provider Enumeration Date | 10/22/2020 |
| Last Update Date | 03/13/2024 |
| Certification Date | 03/13/2024 |
| Medicare PECOS PAC ID | 6406293315 |
|---|---|
| Medicare Enrollment ID | O20240327000111 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841899671 | NPI | - | NPPES |
| 326549937001 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Renee Yvonne Lee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952937229 PECOS PAC ID: 2769813948 Enrollment ID: I20200505000035 |
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