| Prairie Psychotherapy Services Llc | |
|
335 N River St Suite 210 Batavia IL 60510-2386 | |
| (630) 879-8164 | |
| Not Available |
| Full Name | Prairie Psychotherapy Services Llc |
|---|---|
| Speciality | Psychologist |
| Location | 335 N River St, Batavia, Illinois |
| Authorized Official Name and Position | Amy H. Macdonald (OWNER) |
| Authorized Official Contact | 6308798164 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Psychotherapy Services Llc 335 N River St #210 Batavia IL 60510 Ph: (630) 879-8164 | Prairie Psychotherapy Services Llc 335 N River St Suite 210 Batavia IL 60510-2386 Ph: (630) 879-8164 |
| NPI Number | 1497067292 |
|---|---|
| Provider Enumeration Date | 07/08/2010 |
| Last Update Date | 11/30/2023 |
| Certification Date | 11/30/2023 |
| Medicare PECOS PAC ID | 6709239387 |
|---|---|
| Medicare Enrollment ID | O20240131000332 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497067292 | NPI | - | NPPES |
| 4523298 | Other | IL | BLUE CROSS BLUE SHIELD OF ILLINOIS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071005595 (Illinois) | Primary |
| Provider Name | Diane F Mittelhauser |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497815617 PECOS PAC ID: 4284643040 Enrollment ID: I20110516000585 |
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