| Mindshift Center, Llc | |
|
120 S 10th St Quincy IL 62301-4008 | |
| (217) 440-6247 | |
| Not Available |
| Full Name | Mindshift Center, Llc |
|---|---|
| Speciality | Counselor |
| Location | 120 S 10th St, Quincy, Illinois |
| Authorized Official Name and Position | Angel Knoverek (OWNER) |
| Authorized Official Contact | 2174406247 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindshift Center, Llc 120 S 10th St Quincy IL 62301-4008 Ph: (217) 440-6247 | Mindshift Center, Llc 120 S 10th St Quincy IL 62301-4008 Ph: (217) 440-6247 |
| NPI Number | 1194331447 |
|---|---|
| Provider Enumeration Date | 09/22/2020 |
| Last Update Date | 09/25/2023 |
| Certification Date | 09/25/2023 |
| Medicare PECOS PAC ID | 8325486665 |
|---|---|
| Medicare Enrollment ID | O20240404003036 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194331447 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Angel Knoverek |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417242157 PECOS PAC ID: 2567813645 Enrollment ID: I20240404003497 |
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