| Telos Health And Wellness Services, Llc | |
|
907 W Marketview Dr Ste 10 Champaign IL 61822-1250 | |
| (217) 898-5160 | |
| Not Available |
| Full Name | Telos Health And Wellness Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 907 W Marketview Dr Ste 10, Champaign, Illinois |
| Authorized Official Name and Position | Marissa Jonal Harris (CLINICAL COUNSELOR) |
| Authorized Official Contact | 2178985160 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Telos Health And Wellness Services, Llc 907 W Marketview Dr Ste 10 Champaign IL 61822-1250 Ph: (217) 898-5160 | Telos Health And Wellness Services, Llc 907 W Marketview Dr Ste 10 Champaign IL 61822-1250 Ph: (217) 898-5160 |
| NPI Number | 1336759620 |
|---|---|
| Provider Enumeration Date | 08/03/2020 |
| Last Update Date | 08/03/2020 |
| Certification Date | 08/03/2020 |
| Medicare PECOS PAC ID | 4981077039 |
|---|---|
| Medicare Enrollment ID | O20230310001284 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336759620 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Marissa Jonal Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659410082 PECOS PAC ID: 5890168942 Enrollment ID: I20230310001370 |
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