| Tyler Pena, | |
|
10537 S Roberts Rd, Palos Hills, IL 60465-1933 | |
| (708) 974-2300 | |
| (708) 974-2498 |
| Full Name | Tyler Pena |
|---|---|
| Gender | Male |
| Speciality | Counselor - Professional |
| Location | 10537 S Roberts Rd, Palos Hills, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518457365 | NPI | - | NPPES |
| 36216-7940 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 180014127 (Illinois) | Primary |
| 101YM0800X | Counselor - Mental Health | (Illinois) | Secondary |
| 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 |
|---|---|
| Tyler Pena, 10537 S Roberts Rd, Palos Hills, IL 60465-1933 Ph: (708) 974-2300 | Tyler Pena, 10537 S Roberts Rd, Palos Hills, IL 60465-1933 Ph: (708) 974-2300 |
Brenda Copeland, CADC, CAMSII Counselor Medicare: Not Enrolled in Medicare Practice Location: 9944 S Roberts Rd Ste 208, Palos Hills, IL 60465 Phone: 708-599-4220 | |
Ms. Kymberly Norton, Counselor Medicare: Not Enrolled in Medicare Practice Location: 10537 South Roberts Road, Palos Hills, IL 60465 Phone: 708-233-6685 | |
Miss Audrey Ann Wynne, MHP Counselor Medicare: Not Enrolled in Medicare Practice Location: 10537 S Roberts Rd, Palos Hills, IL 60465 Phone: 708-233-6685 Fax: 708-233-0231 | |
Ms. Shatara Powell, Counselor Medicare: Not Enrolled in Medicare Practice Location: 10537 S Roberts Rd, Palos Hills, IL 60465 Phone: 312-543-4693 | |
Lexi Dryier, Counselor Medicare: Not Enrolled in Medicare Practice Location: 10661 S Roberts Rd, Palos Hills, IL 60465 Phone: 708-714-0095 | |
Maria Susana Cedeno, LCPC, CCTP, ICDVP Counselor Medicare: Not Enrolled in Medicare Practice Location: 10537 S Roberts Rd, Palos Hills, IL 60465 Phone: 708-974-5133 Fax: 312-986-4315 | |
Mr. Benito, Jr. Garcia, LCPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 10537 S Roberts Rd, Palos Hills, IL 60465 Phone: 708-974-5127 Fax: 708-974-2498 |