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NPI Code Detail

MEDICARE: HOPE CLINICAL CARE

MEDICARE: HOPE CLINICAL CARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor
2103TC0700XClinical Psychologist
3225XP0019XPhysical Rehabilitation Occupational Therapist
4235Z00000XSpeech-Language Pathologist
5251S00000XCommunity/Behavioral Health Agency
6103K00000XBehavior Analyst

General Provider Information

NPI Number : 1437686870
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOPE CLINICAL CARE
Provider Business Mailing Address
First Line : 15 E HAZEL DELL LN
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62712-4210
Country : US
Telephone Number : 217-585-5134
Fax Number :
Provider Business Practice Location Address
First Line : 5220 6TH STREET FRONTAGE RD E STE 1700
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-5771
Country : US
Telephone Number : 217-525-8332
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. CLINT WILLIAM PAUL
Credential :
Telephone Number : 217-585-5134
Provider Enumeration Date : 05/16/2017
Last Update Date : 05/16/2017

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Directions to “HOPE CLINICAL CARE ” Practice Location

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