| Ipsative Psychology, Pllc | |
|
2501 Chatham Rd # 5212 Springfield IL 62704-4188 | |
| (312) 463-9299 | |
| Not Available |
| Full Name | Ipsative Psychology, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2501 Chatham Rd # 5212, Springfield, Illinois |
| Authorized Official Name and Position | Erica Goodman (OWNER) |
| Authorized Official Contact | 3124639299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ipsative Psychology, Pllc 2501 Chatham Rd # 5212 Springfield IL 62704-4188 Ph: (312) 463-9299 | Ipsative Psychology, Pllc 2501 Chatham Rd # 5212 Springfield IL 62704-4188 Ph: (312) 463-9299 |
| NPI Number | 1376303644 |
|---|---|
| Provider Enumeration Date | 03/21/2024 |
| Last Update Date | 03/21/2024 |
| Certification Date | 03/21/2024 |
| Medicare PECOS PAC ID | 1052858230 |
|---|---|
| Medicare Enrollment ID | O20240806001467 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376303644 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Erica Goodman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982357737 PECOS PAC ID: 3870987076 Enrollment ID: I20220304000981 |
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