| Christianne Judy Lcsw Llc | |
|
635 S Lincoln Ave O Fallon IL 62269-2663 | |
| (314) 518-7897 | |
| Not Available |
| Full Name | Christianne Judy Lcsw Llc |
|---|---|
| Speciality | Counselor |
| Location | 635 S Lincoln Ave, O Fallon, Illinois |
| Authorized Official Name and Position | Christianne M Judy (PSYCHOTHERAPIST) |
| Authorized Official Contact | 3145187897 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Christianne Judy Lcsw Llc 635 S Lincoln Ave O Fallon IL 62269-2663 Ph: (314) 518-7897 | Christianne Judy Lcsw Llc 635 S Lincoln Ave O Fallon IL 62269-2663 Ph: (314) 518-7897 |
| NPI Number | 1922572148 |
|---|---|
| Provider Enumeration Date | 01/22/2019 |
| Last Update Date | 06/05/2020 |
| Certification Date | 06/05/2020 |
| Medicare PECOS PAC ID | 9335480458 |
|---|---|
| Medicare Enrollment ID | O20190417002208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922572148 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Christianne M Judy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023186806 PECOS PAC ID: 2860591708 Enrollment ID: I20070619000166 |
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