| Coffee Clutch Counseling Services, Llc | |
|
2151 Lafayette Ave Ste 105 Terre Haute IN 47805-2910 | |
| (315) 408-9379 | |
| (561) 282-3238 |
| Full Name | Coffee Clutch Counseling Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2151 Lafayette Ave Ste 105, Terre Haute, Indiana |
| Authorized Official Name and Position | Rebecca Chambers (OWNER) |
| Authorized Official Contact | 3154089379 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coffee Clutch Counseling Services, Llc 2151 Lafayette Ave Ste 105 Terre Haute IN 47805-2910 Ph: (315) 408-9379 | Coffee Clutch Counseling Services, Llc 2151 Lafayette Ave Ste 105 Terre Haute IN 47805-2910 Ph: (315) 408-9379 |
| NPI Number | 1477027696 |
|---|---|
| Provider Enumeration Date | 01/22/2019 |
| Last Update Date | 03/01/2019 |
| Medicare PECOS PAC ID | 5698015089 |
|---|---|
| Medicare Enrollment ID | O20190321001805 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477027696 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Rosita Fernandez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376062851 PECOS PAC ID: 7416221502 Enrollment ID: I20170928001916 |
| Provider Name | Rebecca Lynn Chambers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033366638 PECOS PAC ID: 3173890191 Enrollment ID: I20171206001136 |
| Provider Name | Melissa Burns |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285190041 PECOS PAC ID: 9537409115 Enrollment ID: I20190318001728 |
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