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6845 Weaver Rd Ste 100 Rockford IL 61114-8051 | |
| (815) 324-3979 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 6845 Weaver Rd Ste 100, Rockford, Illinois |
| Authorized Official Name and Position | Jonathan Scott Nelson (MANAGING MEMBER) |
| Authorized Official Contact | 8152223958 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
9861 Aberdeen Ln Huntley IL 60142-2433 Ph: () - | 6845 Weaver Rd Ste 100 Rockford IL 61114-8051 Ph: (815) 324-3979 |
| NPI Number | 1932685542 |
|---|---|
| Provider Enumeration Date | 07/17/2018 |
| Last Update Date | 08/31/2024 |
| Certification Date | 08/31/2024 |
| Medicare PECOS PAC ID | 9830639517 |
|---|---|
| Medicare Enrollment ID | O20240909002500 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932685542 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 180007240 (Illinois) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Jonathan Nelson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497982151 PECOS PAC ID: 6103273339 Enrollment ID: I20240909002679 |
| Provider Name | Ashley Baylor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124861992 PECOS PAC ID: 3971043662 Enrollment ID: I20240909003149 |
| Provider Name | Leila Nelson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235511775 PECOS PAC ID: 8426598087 Enrollment ID: I20240910001415 |
| Provider Name | Monica K Benton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780204289 PECOS PAC ID: 7517407182 Enrollment ID: I20240910001848 |
| Provider Name | Dawn Elizabeth Rolander |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063247039 PECOS PAC ID: 2264966654 Enrollment ID: I20241107001653 |
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