| Methodist | |
|
221 Ne Glen Oak Ave Peoria IL 61636-0001 | |
| (309) 672-5604 | |
| Not Available |
| Full Name | Methodist |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 221 Ne Glen Oak Ave, Peoria, Illinois |
| Authorized Official Name and Position | Christopher Legan (PHP THERAPIST) |
| Authorized Official Contact | 3096725604 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Methodist 221 Ne Glen Oak Ave Peoria IL 61636-0001 Ph: (309) 672-5604 | Methodist 221 Ne Glen Oak Ave Peoria IL 61636-0001 Ph: (309) 672-5604 |
| NPI Number | 1811512411 |
|---|---|
| Provider Enumeration Date | 06/10/2020 |
| Last Update Date | 06/10/2020 |
| Certification Date | 06/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811512411 | NPI | - | NPPES |
| 180007159 | Other | IL | LCPC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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