| Optimal Change, Llc | |
|
2001 Maine St. Suite 102 Quincy IL 62301-4345 | |
| (217) 740-2719 | |
| (217) 214-8005 |
| Full Name | Optimal Change, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2001 Maine St., Quincy, Illinois |
| Authorized Official Name and Position | Kettisha Hodges (BEHAVIORAL HEALTH THERAPIST) |
| Authorized Official Contact | 5734062473 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimal Change, Llc 2001 Maine St. Suite 102 Quincy IL 62301-4345 Ph: (217) 740-2719 | Optimal Change, Llc 2001 Maine St. Suite 102 Quincy IL 62301-4345 Ph: (217) 740-2719 |
| NPI Number | 1578134268 |
|---|---|
| Provider Enumeration Date | 07/05/2021 |
| Last Update Date | 07/05/2021 |
| Certification Date | 07/05/2021 |
| Medicare PECOS PAC ID | 7012308125 |
|---|---|
| Medicare Enrollment ID | O20211228002215 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578134268 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Kettisha M Hodges |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235425620 PECOS PAC ID: 9638349103 Enrollment ID: I20151027002913 |
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