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4047 Center Ave Lyons IL 60534-1315 | |
(773) 425-1232 | |
Not Available |
Full Name | |
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Speciality | Counselor - Professional |
Location | 4047 Center Ave, Lyons, Illinois |
Authorized Official Name and Position | Blake M Adams (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 7734251232 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4047 Center Ave Lyons IL 60534-1315 Ph: (773) 425-1232 | 4047 Center Ave Lyons IL 60534-1315 Ph: (773) 425-1232 |
NPI Number | 1003649484 |
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Provider Enumeration Date | 08/21/2024 |
Last Update Date | 11/22/2024 |
Certification Date | 11/22/2024 |
Identifier | Type | State | Issuer |
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1003649484 | NPI | - | NPPES |
1932834785 | Medicaid | IL | |
1881688307 | Medicaid | IL |