| Blair Counseling And Mediation Pc | |
|
600 Dakota St Ste B Crystal Lake IL 60012-3742 | |
| (815) 276-3947 | |
| (815) 356-8975 |
| Full Name | Blair Counseling And Mediation Pc |
|---|---|
| Speciality | Counselor |
| Location | 600 Dakota St Ste B, Crystal Lake, Illinois |
| Authorized Official Name and Position | Dan K Blair (OWNER) |
| Authorized Official Contact | 8152763947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blair Counseling And Mediation Pc 600 Dakota St Ste B Crystal Lake IL 60012-3742 Ph: (815) 276-3947 | Blair Counseling And Mediation Pc 600 Dakota St Ste B Crystal Lake IL 60012-3742 Ph: (815) 276-3947 |
| NPI Number | 1245479674 |
|---|---|
| Provider Enumeration Date | 02/09/2009 |
| Last Update Date | 06/07/2018 |
| Medicare PECOS PAC ID | 9032515796 |
|---|---|
| Medicare Enrollment ID | O20210903000007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245479674 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Secondary |
| Provider Name | Kathleen M Deroche |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528067824 PECOS PAC ID: 9436245115 Enrollment ID: I20071010000537 |
| Provider Name | Carlos Acosta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598913345 PECOS PAC ID: 1850797515 Enrollment ID: I20210903000011 |
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