Anxiety and Stress Relief Center PLLC
Organization Active NPI Clinical Social Worker · Breese, IL
NPI 1619686417 · NPPES record last updated Jan 11, 2024
Key facts
- NPI
- 1619686417
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- ANXIETY AND STRESS RELIEF CENTER PLLC
- Practice address
- 110 N Main St
Breese, IL 62230-1630 - Phone
- (618) 322-6424
- Fax
- (618) 227-8227
- NPI assigned
- Nov 21, 2022
- Organization subpart
- No
Authorized official
- Name
- Ms. Christina R Diesen, LCSW
- Title
- Owner/Provider
- Phone
- (618) 322-6424
Practitioners 2
-
Christina R Diesen, LCSW
-
Kim R Peek, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240209002480 | IL | Part B Supplier - Clinic/Group Practice | 7012350739 |
Receives reassigned benefits from 1 practitioner Practice locations: Breese, IL |
National Provider Directory
Locations
110 N Main St
Breese, IL 62230
Phone (618) 322-6424
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | Yes |
Addresses
Primary practice location
110 N Main St
Breese, IL 62230-1630
Mailing address
110 N Main St
Breese, IL 62230-1630
Phone (618) 322-6424
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All providers in Breese, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.