| Stateline Counseling Services Llc | |
|
1107 N Blackhawk Blvd Suite 8 Rockton IL 61072-1500 | |
| (815) 494-9115 | |
| (815) 926-5301 |
| Full Name | Stateline Counseling Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1107 N Blackhawk Blvd, Rockton, Illinois |
| Authorized Official Name and Position | Shelly Lynne Patchett (OWNER) |
| Authorized Official Contact | 8154949115 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stateline Counseling Services Llc 2218 Crosby St Rockford IL 61107-4454 Ph: (815) 464-9115 | Stateline Counseling Services Llc 1107 N Blackhawk Blvd Suite 8 Rockton IL 61072-1500 Ph: (815) 494-9115 |
| NPI Number | 1033551320 |
|---|---|
| Provider Enumeration Date | 07/26/2013 |
| Last Update Date | 07/26/2013 |
| Medicare PECOS PAC ID | 8729201686 |
|---|---|
| Medicare Enrollment ID | O20140521001347 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033551320 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149.009828 (Illinois) | Primary |
| Provider Name | Shelly L Patchett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215070487 PECOS PAC ID: 3577786243 Enrollment ID: I20140527001480 |
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