| Persimmon Tree Counseling, Llc | |
|
207 W Jefferson St Ste 401 Bloomington IL 61701-3969 | |
| (309) 431-1296 | |
| Not Available |
| Full Name | Persimmon Tree Counseling, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 207 W Jefferson St Ste 401, Bloomington, Illinois |
| Authorized Official Name and Position | Matthew Hickman (MANAGER) |
| Authorized Official Contact | 3094311296 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Persimmon Tree Counseling, Llc 807 S Grove St Normal IL 61761-2840 Ph: (309) 287-6379 | Persimmon Tree Counseling, Llc 207 W Jefferson St Ste 401 Bloomington IL 61701-3969 Ph: (309) 431-1296 |
| NPI Number | 1710610613 |
|---|---|
| Provider Enumeration Date | 07/07/2022 |
| Last Update Date | 07/12/2022 |
| Certification Date | 07/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710610613 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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