| William R White Counseling & Psychotherapy Pc | |
|
712 E Empire St Bloomington IL 61701-3252 | |
| (309) 287-9464 | |
| (309) 827-7576 |
| Full Name | William R White Counseling & Psychotherapy Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 712 E Empire St, Bloomington, Illinois |
| Authorized Official Name and Position | William R White (PRESIDENT) |
| Authorized Official Contact | 3092879464 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| William R White Counseling & Psychotherapy Pc 712 E Empire St Bloomington IL 61701-3252 Ph: (309) 287-9464 | William R White Counseling & Psychotherapy Pc 712 E Empire St Bloomington IL 61701-3252 Ph: (309) 287-9464 |
| NPI Number | 1447559356 |
|---|---|
| Provider Enumeration Date | 03/17/2011 |
| Last Update Date | 03/17/2011 |
| Medicare PECOS PAC ID | 3072896562 |
|---|---|
| Medicare Enrollment ID | O20170207002172 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447559356 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 149.004861 (Illinois) | Primary |
| Provider Name | William R White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356521280 PECOS PAC ID: 6507149093 Enrollment ID: I20170207002186 |
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