| Blue Lavender Clinical Services Llc | |
|
2325 Dean Street Suite 500 St. Charles IL 60175 | |
| (630) 962-2761 | |
| Not Available |
| Full Name | Blue Lavender Clinical Services Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2325 Dean Street, St. Charles, Illinois |
| Authorized Official Name and Position | Karen Hammond (LCSW; OWNER) |
| Authorized Official Contact | 6309622761 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Lavender Clinical Services Llc 2325 Dean Street Suite 500 St. Charles IL 60175 Ph: (630) 962-2761 | Blue Lavender Clinical Services Llc 2325 Dean Street Suite 500 St. Charles IL 60175 Ph: (630) 962-2761 |
| NPI Number | 1932879459 |
|---|---|
| Provider Enumeration Date | 09/16/2021 |
| Last Update Date | 02/27/2024 |
| Certification Date | 09/16/2021 |
| Medicare PECOS PAC ID | 7214306661 |
|---|---|
| Medicare Enrollment ID | O20221207002095 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932879459 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Karen Hammond |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275032336 PECOS PAC ID: 0941679393 Enrollment ID: I20221207002218 |
| Provider Name | Shawn Nowotnik |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740947373 PECOS PAC ID: 4880063247 Enrollment ID: I20221207002460 |
Vianova Psychology, Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 412 S. 2nd St., St. Charles, IL 60174 Phone: 630-492-0052 | |
Leahy & Associates, P.c. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 475 Dunham Rd, Suite G, St. Charles, IL 60174 Phone: 630-849-3711 |