| Kaleidoscope Heart Counseling, Llc | |
|
115 Lincoln Place Ct Ste 102 Belleville IL 62221-5876 | |
| (618) 722-9616 | |
| Not Available |
| Full Name | Kaleidoscope Heart Counseling, Llc |
|---|---|
| Speciality | Counselor |
| Location | 115 Lincoln Place Ct Ste 102, Belleville, Illinois |
| Authorized Official Name and Position | Tanya Renee Koelker (OWNER) |
| Authorized Official Contact | 6187229616 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kaleidoscope Heart Counseling, Llc 115 Lincoln Place Ct Ste 102 Belleville IL 62221-5876 Ph: (618) 722-9616 | Kaleidoscope Heart Counseling, Llc 115 Lincoln Place Ct Ste 102 Belleville IL 62221-5876 Ph: (618) 722-9616 |
| NPI Number | 1376378562 |
|---|---|
| Provider Enumeration Date | 09/05/2024 |
| Last Update Date | 01/23/2025 |
| Certification Date | 01/23/2025 |
| Medicare PECOS PAC ID | 4385177302 |
|---|---|
| Medicare Enrollment ID | O20241030000621 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376378562 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Tanya Renee Koelker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902638653 PECOS PAC ID: 6103359120 Enrollment ID: I20241030000700 |
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