| Springfield Psychological Center, Llc | |
|
2325 W White Oaks Dr Suite C Springfield IL 62704-7419 | |
| (217) 793-3949 | |
| (217) 793-3995 |
| Full Name | Springfield Psychological Center, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2325 W White Oaks Dr, Springfield, Illinois |
| Authorized Official Name and Position | Melissa Fisher Paoni (PARTNER) |
| Authorized Official Contact | 2177933949 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Springfield Psychological Center, Llc 2325 W White Oaks Dr Suite C Springfield IL 62704-7419 Ph: (217) 793-3949 | Springfield Psychological Center, Llc 2325 W White Oaks Dr Suite C Springfield IL 62704-7419 Ph: (217) 793-3949 |
| NPI Number | 1174749881 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 01/12/2017 |
| Medicare PECOS PAC ID | 9234411042 |
|---|---|
| Medicare Enrollment ID | O20170131000077 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174749881 | NPI | - | NPPES |
| Provider Name | Loretta K Mckenzie |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922108885 PECOS PAC ID: 9436192176 Enrollment ID: I20050603000794 |
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