| Charles Michael Ideran, DMIN, LCPC | |
|
6006 W. 159th St, Bldg. C, Oak Forest, IL 60452 | |
| (708) 535-7320 | |
| Not Available |
| Full Name | Charles Michael Ideran |
|---|---|
| Gender | Male |
| Speciality | Counselor - Mental Health |
| Location | 6006 W. 159th St, Oak Forest, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265446652 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 180001087 (Illinois) | Secondary |
| 101YM0800X | Counselor - Mental Health | LCPC 180-001087 (Illinois) | Primary |
| Entity Name | Genesis Therapy Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1447264890 PECOS PAC ID: 9436461720 Enrollment ID: O20150629002166 |
| Mailing Address | Practice Location Address |
|---|---|
| Charles Michael Ideran, DMIN, LCPC 1404 Brassie Ave, Flossmoor, IL 60422-1814 Ph: (708) 922-1194 | Charles Michael Ideran, DMIN, LCPC 6006 W. 159th St, Bldg. C, Oak Forest, IL 60452 Ph: (708) 535-7320 |
Ms. Maura L Maloney, M.A., L.P.C. Counselor Medicare: Not Enrolled in Medicare Practice Location: 6006 159th St Ste C, Oak Forest, IL 60452 Phone: 630-724-0246 | |
Dawn Vance, MA Counselor Medicare: Medicare Enrolled Practice Location: 5320 159th St Ste 100, Oak Forest, IL 60452 Phone: 708-381-5009 Fax: 708-381-5026 | |
Jennifer Alice Boender, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 15601 Cicero Ave, Suite 103, Oak Forest, IL 60452 Phone: 708-687-3479 | |
Sara Evin Allen, Counselor Medicare: Not Enrolled in Medicare Practice Location: 6006 159th St Bldg C, Oak Forest, IL 60452 Phone: 708-545-7320 | |
Barbara L Grevengoed, LCPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 6006 W 159th Street, Oak Forest, IL 60452 Phone: 708-535-7320 Fax: 708-535-7571 | |
Mr. Timothy Michael Jenkins, M.A. Counselor Medicare: Medicare Enrolled Practice Location: 5320 159th St Ste 100, Oak Forest, IL 60452 Phone: 708-275-0934 Fax: 708-827-0485 | |
Mrs. Kimberly Joy De Jong, MA, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 6006 159th St Bldg C, The Genesis Therapy Center, Oak Forest, IL 60452 Phone: 708-535-7320 |