| Portrait Health Centers | |
|
175 E Hawthorn Pkwy Suite 235 Vernon Hills IL 60061-1463 | |
| (847) 868-3435 | |
| (847) 859-5885 |
| Full Name | Portrait Health Centers |
|---|---|
| Speciality | Psychologist |
| Location | 175 E Hawthorn Pkwy, Vernon Hills, Illinois |
| Authorized Official Name and Position | Jeremy Warner (PRACTICE MANAGER) |
| Authorized Official Contact | 8478683435 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Portrait Health Centers 175 E Hawthorn Pkwy Suite 235 Vernon Hills IL 60061-1463 Ph: (847) 868-3435 | Portrait Health Centers 175 E Hawthorn Pkwy Suite 235 Vernon Hills IL 60061-1463 Ph: (847) 868-3435 |
| NPI Number | 1235430612 |
|---|---|
| Provider Enumeration Date | 11/16/2010 |
| Last Update Date | 09/06/2013 |
| Medicare PECOS PAC ID | 7416194683 |
|---|---|
| Medicare Enrollment ID | O20130507000222 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235430612 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 071007099 (Illinois) | Primary |
| 133V00000X | Dietitian, Registered | 164005333 (Illinois) | Secondary |
| Provider Name | Steven E Hurley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548339955 PECOS PAC ID: 3870699275 Enrollment ID: I20070501000590 |
| Provider Name | Gurinder Vicki Bolina |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083841951 PECOS PAC ID: 6901091636 Enrollment ID: I20121214000089 |
| Provider Name | Jessica L Funk |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891035903 PECOS PAC ID: 4880828532 Enrollment ID: I20131011000337 |
| Provider Name | John Beltramo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184778748 PECOS PAC ID: 0244467413 Enrollment ID: I20131213000653 |
| Provider Name | Jeana D Lucarelli |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184998213 PECOS PAC ID: 7113155706 Enrollment ID: I20140103000984 |
| Provider Name | Robin Leigh Zoeller Pullman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922497429 PECOS PAC ID: 0446530851 Enrollment ID: I20161130002193 |
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