| Mchenry | |
|
620 Dakota St Crystal Lake IL 60012-3732 | |
| (773) 572-5500 | |
| Not Available |
| Full Name | Mchenry |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 620 Dakota St, Crystal Lake, Illinois |
| Authorized Official Name and Position | Marcella Klauer (EXECUTIVE ASSISTANT) |
| Authorized Official Contact | 7735725480 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mchenry 4101 N Ravenswood Ave Chicago IL 60613-2193 Ph: (773) 572-5500 | Mchenry 620 Dakota St Crystal Lake IL 60012-3732 Ph: (773) 572-5500 |
| NPI Number | 1700274750 |
|---|---|
| Provider Enumeration Date | 12/29/2014 |
| Last Update Date | 07/14/2022 |
| Certification Date | 07/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700274750 | NPI | - | NPPES |
| 04133 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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