| Pck Behavioral Health Group | |
|
47 Katrina Ln Sleepy Hollow IL 60118-3123 | |
| (224) 699-0196 | |
| Not Available |
| Full Name | Pck Behavioral Health Group |
|---|---|
| Speciality | Counselor |
| Location | 47 Katrina Ln, Sleepy Hollow, Illinois |
| Authorized Official Name and Position | Phetsavanh C Coggin (OWNER) |
| Authorized Official Contact | 2246990196 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pck Behavioral Health Group 47 Katrina Ln Sleepy Hollow IL 60118-3123 Ph: () - | Pck Behavioral Health Group 47 Katrina Ln Sleepy Hollow IL 60118-3123 Ph: (224) 699-0196 |
| NPI Number | 1477286805 |
|---|---|
| Provider Enumeration Date | 07/04/2022 |
| Last Update Date | 07/06/2022 |
| Certification Date | 07/06/2022 |
| Medicare PECOS PAC ID | 0446634869 |
|---|---|
| Medicare Enrollment ID | O20220903000350 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477286805 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Phetsavanh Coggin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336537745 PECOS PAC ID: 1355725771 Enrollment ID: I20240614002557 |
Tcpcindustries Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 47 Katrina Ln, Sleepy Hollow, IL 60118 Phone: 847-942-0555 |