| 1402 Cockrell Llc | |
|
4012 Cockrell Ln Springfield IL 62711-8327 | |
| (847) 324-3543 | |
| Not Available |
| Full Name | 1402 Cockrell Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4012 Cockrell Ln, Springfield, Illinois |
| Authorized Official Name and Position | Sariah Hopkins (COMPLIANCE OFFICER) |
| Authorized Official Contact | 8473243543 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 1402 Cockrell Llc 6317 N Monticello Ave Chicago IL 60659-1209 Ph: (847) 324-3543 | 1402 Cockrell Llc 4012 Cockrell Ln Springfield IL 62711-8327 Ph: (847) 324-3543 |
| NPI Number | 1184590747 |
|---|---|
| Provider Enumeration Date | 10/13/2025 |
| Last Update Date | 10/13/2025 |
| Certification Date | 10/13/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184590747 | NPI | - | NPPES |
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