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800 W Main St Carbondale IL 62901-2538 | |
| (618) 529-2273 | |
| (618) 549-8321 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 800 W Main St, Carbondale, Illinois |
| Authorized Official Name and Position | Monika Plumb (PSYCHOTHERAPIST) |
| Authorized Official Contact | 6185292273 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
800 W Main St Carbondale IL 62901-2538 Ph: (618) 529-2273 | 800 W Main St Carbondale IL 62901-2538 Ph: (618) 529-2273 |
| NPI Number | 1740337468 |
|---|---|
| Provider Enumeration Date | 01/04/2007 |
| Last Update Date | 12/10/2007 |
| Medicare PECOS PAC ID | 5395823108 |
|---|---|
| Medicare Enrollment ID | O20080418000566 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740337468 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Gordon B Plumb |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831106970 PECOS PAC ID: 4789628447 Enrollment ID: I20080418000568 |
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