| Outreach Community Counseling Center In Carol Stream | |
|
122 W Liberty Dr Wheaton IL 60187-5124 | |
| (630) 682-1910 | |
| (630) 682-0655 |
| Full Name | Outreach Community Counseling Center In Carol Stream |
|---|---|
| Speciality | Clinic/Center |
| Location | 122 W Liberty Dr, Wheaton, Illinois |
| Authorized Official Name and Position | Brian T. Lux (DIRECTOR OF CLINICAL SERVICES) |
| Authorized Official Contact | 6306821910 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Outreach Community Counseling Center In Carol Stream 373 S Schmale Rd Ste 102 Carol Stream IL 60188-2771 Ph: (630) 682-1910 | Outreach Community Counseling Center In Carol Stream 122 W Liberty Dr Wheaton IL 60187-5124 Ph: (630) 682-1910 |
| NPI Number | 1255443669 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 01/15/2021 |
| Certification Date | 01/15/2021 |
| Medicare PECOS PAC ID | 6103188016 |
|---|---|
| Medicare Enrollment ID | O20180313000045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255443669 | NPI | - | NPPES |
| 02232105 | Other | IL | BLUE CROSS BLUE SHIELD |
| Provider Name | Jessica Marshall |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457667776 PECOS PAC ID: 3779842646 Enrollment ID: I20180123000567 |
| Provider Name | Sandra Oyler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366693525 PECOS PAC ID: 1951663889 Enrollment ID: I20180313000754 |
| Provider Name | Aimee Maas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760997993 PECOS PAC ID: 4981969755 Enrollment ID: I20180525001554 |
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