| The Circle Of The Society Of Helpers | |
|
2648 W Pershing Rd Chicago IL 60632-1629 | |
| (872) 444-5148 | |
| (872) 444-5148 |
| Full Name | The Circle Of The Society Of Helpers |
|---|---|
| Speciality | Psychologist |
| Location | 2648 W Pershing Rd, Chicago, Illinois |
| Authorized Official Name and Position | Alicia Gutierrez (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8724445148 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Circle Of The Society Of Helpers 2648 W Pershing Rd Chicago IL 60632-1629 Ph: (872) 444-5148 | The Circle Of The Society Of Helpers 2648 W Pershing Rd Chicago IL 60632-1629 Ph: (872) 444-5148 |
| NPI Number | 1285181438 |
|---|---|
| Provider Enumeration Date | 09/06/2016 |
| Last Update Date | 05/20/2020 |
| Certification Date | 05/20/2020 |
| Medicare PECOS PAC ID | 0042592818 |
|---|---|
| Medicare Enrollment ID | O20170131002372 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285181438 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071002095 (Illinois) | Primary |
| 103TC0700X | Psychologist - Clinical | 071-002095 (Illinois) | Secondary |
| Provider Name | Mary Ellen Moore |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487735940 PECOS PAC ID: 6709044076 Enrollment ID: I20120220000292 |
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