| Max Smith, | |
|
103 W Main St Ste 6, Oblong, IL 62449-1165 | |
| (618) 636-0719 | |
| Not Available |
| Full Name | Max Smith |
|---|---|
| Gender | Male |
| Speciality | Counselor - Professional |
| Location | 103 W Main St Ste 6, Oblong, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548933146 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 180016323 (Illinois) | Primary |
| 101YP2500X | Counselor - Professional | 178017178 (Illinois) | Secondary |
| Entity Name | Edgewood Clinical Services P.c. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1295914646 PECOS PAC ID: 3971963901 Enrollment ID: O20230721001228 |
| Entity Name | Pivot Counseling & Consulting, Ltd |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1386457026 PECOS PAC ID: 8224555842 Enrollment ID: O20250507002233 |
| Mailing Address | Practice Location Address |
|---|---|
| Max Smith, 103 W Main St Ste 6, Oblong, IL 62449-1165 Ph: () - | Max Smith, 103 W Main St Ste 6, Oblong, IL 62449-1165 Ph: (618) 636-0719 |
Mrs. Jodi L Wiman, MA Counselor Medicare: Medicare Enrolled Practice Location: 103 W Main St, Suite 5, Oblong, IL 62449 Phone: 618-592-3116 Fax: 618-592-3117 | |
Mrs. Marcia Thorsen, LCPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 108 S Garfield St, Oblong, IL 62449 Phone: 618-769-2185 |