| Kaleidoscope Center Corp | |
|
630 Pierce Blvd Ste 300 O Fallon IL 62269-2583 | |
| (618) 221-9677 | |
| Not Available |
| Full Name | Kaleidoscope Center Corp |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 630 Pierce Blvd Ste 300, O Fallon, Illinois |
| Authorized Official Name and Position | Rachel Minelli (OWNER/CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 6182219677 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kaleidoscope Center Corp 7020 Fairbanks St O Fallon IL 62269-7076 Ph: () - | Kaleidoscope Center Corp 630 Pierce Blvd Ste 300 O Fallon IL 62269-2583 Ph: (618) 221-9677 |
| NPI Number | 1669240867 |
|---|---|
| Provider Enumeration Date | 12/18/2023 |
| Last Update Date | 12/18/2023 |
| Certification Date | 12/17/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669240867 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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