| Mr Ronald Martinez, LCPC | |
|
550 Oaklawn Ave, East Moline, IL 61244-4030 | |
| (309) 792-1074 | |
| Not Available |
| Full Name | Mr Ronald Martinez |
|---|---|
| Gender | Male |
| Speciality | Counselor |
| Location | 550 Oaklawn Ave, East Moline, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457415325 | NPI | - | NPPES |
| 08132008 | Other | IL | BLUE CROSS BLUE SHIELD IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (Illinois) | Primary |
| Entity Name | Southpark Psychology Ltd |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1558470419 PECOS PAC ID: 8527203090 Enrollment ID: O20130404000285 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Ronald Martinez, LCPC 550 Oaklawn Ave, East Moline, IL 61244 Ph: (309) 792-1074 | Mr Ronald Martinez, LCPC 550 Oaklawn Ave, East Moline, IL 61244-4030 Ph: (309) 792-1074 |
Kenneth Warren, CADC, CODP I Counselor Medicare: Not Enrolled in Medicare Practice Location: 1607 John Deere Rd, East Moline, IL 61244 Phone: 309-792-0292 | |
Mr. Jeffrey A Edwards, MDIV, CADC Counselor Medicare: Not Enrolled in Medicare Practice Location: 926 15th Ave, East Moline, IL 61244 Phone: 309-752-9740 Fax: 309-752-9744 | |
Mrs. Stacy Nicole Bogguess, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 723 15th Ave, East Moline, IL 61244 Phone: 309-316-3500 | |
Ms. Farah E Anderson, LCPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1033 7th St Ste 104, East Moline, IL 61244 Phone: 309-316-3500 | |
Jessica Lynn Mcmorran, LPC, NCC Counselor Medicare: Not Enrolled in Medicare Practice Location: 723 15th Ave, East Moline, IL 61244 Phone: 309-822-2776 | |
Lauren Peterson, Counselor Medicare: Not Enrolled in Medicare Practice Location: 4030 4th Street A, East Moline, IL 61244 Phone: 262-332-1343 |