| Positive Direction Counseling, Pc | |
|
305 N Mill St Pontiac IL 61764-1823 | |
| (815) 822-5133 | |
| (815) 513-6170 |
| Full Name | Positive Direction Counseling, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 305 N Mill St, Pontiac, Illinois |
| Authorized Official Name and Position | Jayme Evelyn Bradshaw (PROPRIETOR) |
| Authorized Official Contact | 8158225133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Direction Counseling, Pc 305 N Mill St Pontiac IL 61764-1823 Ph: (815) 822-5133 | Positive Direction Counseling, Pc 305 N Mill St Pontiac IL 61764-1823 Ph: (815) 822-5133 |
| NPI Number | 1093441719 |
|---|---|
| Provider Enumeration Date | 07/26/2022 |
| Last Update Date | 09/29/2022 |
| Certification Date | 09/29/2022 |
| Medicare PECOS PAC ID | 0547617953 |
|---|---|
| Medicare Enrollment ID | O20231107001404 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093441719 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jayme E Bradshaw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780316166 PECOS PAC ID: 0345697751 Enrollment ID: I20231107001535 |
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