Young Adult Program | |
4219 N Lincoln Ave Chicago IL 60618-2901 | |
(773) 572-5500 | |
(773) 537-3488 |
Full Name | Young Adult Program |
---|---|
Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
Location | 4219 N Lincoln Ave, Chicago, Illinois |
Authorized Official Name and Position | Marcella Klauer (EXECUTIVE ASSISTANT) |
Authorized Official Contact | 7735725480 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Young Adult Program 4101 N Ravenswood Ave Chicago IL 60613-2193 Ph: (773) 572-5500 | Young Adult Program 4219 N Lincoln Ave Chicago IL 60618-2901 Ph: (773) 572-5500 |
NPI Number | 1003062399 |
---|---|
Provider Enumeration Date | 08/18/2008 |
Last Update Date | 07/14/2022 |
Certification Date | 07/14/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003062399 | NPI | - | NPPES |
04133 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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Philip K Mccullough Md Sc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 E Huron St, Suite 11-100, Chicago, IL 60611 Phone: 312-695-3680 Fax: 312-926-3709 | |
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