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219 E Main St Mascoutah IL 62258-2136 | |
| (618) 448-0230 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 219 E Main St, Mascoutah, Illinois |
| Authorized Official Name and Position | James E. Booth (PROFESSIONAL COUNSELOR/MANAGER) |
| Authorized Official Contact | 6187920613 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
219 E Main St Mascoutah IL 62258-2136 Ph: (618) 448-0230 | 219 E Main St Mascoutah IL 62258-2136 Ph: (618) 448-0230 |
| NPI Number | 1114688850 |
|---|---|
| Provider Enumeration Date | 01/05/2022 |
| Last Update Date | 02/09/2022 |
| Certification Date | 02/09/2022 |
| Medicare PECOS PAC ID | 3971036567 |
|---|---|
| Medicare Enrollment ID | O20241105000437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114688850 | NPI | - | NPPES |
| Provider Name | James E. Booth |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285381277 PECOS PAC ID: 4880127471 Enrollment ID: I20241105000613 |
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