| Mary K Evans, LPC, MA | |
|
2917 Crossing Ct Ste B1, Champaign, IL 61822-6185 | |
| (970) 690-1646 | |
| Not Available |
| Full Name | Mary K Evans |
|---|---|
| Gender | Female |
| Speciality | Counselor - Professional |
| Location | 2917 Crossing Ct Ste B1, Champaign, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255789632 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 180.004735 (Illinois) | Secondary |
| 101YP2500X | Counselor - Professional | LPC.0015327 (Colorado) | Primary |
| Entity Name | Vitae Health Medical Illinois, Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1174013452 PECOS PAC ID: 2365798410 Enrollment ID: O20180703002838 |
| Mailing Address | Practice Location Address |
|---|---|
| Mary K Evans, LPC, MA 2506 Fields South Dr Apt 106, Champaign, IL 61822-3713 Ph: (970) 690-1646 | Mary K Evans, LPC, MA 2917 Crossing Ct Ste B1, Champaign, IL 61822-6185 Ph: (970) 690-1646 |
Staci Poe, Counselor Medicare: Not Enrolled in Medicare Practice Location: 44 E Main St, Ste 406, Champaign, IL 61820 Phone: 217-398-9066 Fax: 217-398-9077 | |
Marie Duffin, Counselor Medicare: Not Enrolled in Medicare Practice Location: 701 Devonshire Dr Ste B16-18, Champaign, IL 61820 Phone: 217-531-2360 | |
Jennifer Carleton, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 411 Devonshire Dr, Champaign, IL 61820 Phone: 217-904-3035 | |
Erica Taylor, LPC Counselor Medicare: Medicare Enrolled Practice Location: 2125 S Neil St, Champaign, IL 61820 Phone: 217-352-0200 Fax: 217-607-1139 | |
Rachel Cooper Brown, MS, LPC Counselor Medicare: Medicare Enrolled Practice Location: 309 W Clark St, Champaign, IL 61820 Phone: 217-398-9066 Fax: 217-398-9077 | |
Kenya Kelly, BS Counselor Medicare: Not Enrolled in Medicare Practice Location: 106 S Country Fair Dr, Champaign, IL 61821 Phone: 217-255-3922 | |
Mrs. Anne Marie Tormos, LCPC Counselor Medicare: Medicare Enrolled Practice Location: 206 N Randolph St Ste 246, Champaign, IL 61820 Phone: 833-351-8255 |