S E ILLINOIS COUNSELING CTRS NPI 1013186568

NPI Information

NPI: 1013186568
Provider Name: S E ILLINOIS COUNSELING CTRS

Other Name: WAYNE FAMILY COUNSELING CTR

Classification: Counselor - 101YA0400X
Entity Type: Organization

Specialization: Addiction (Substance Use Disorder)

Address:
407 N BASIN RD
FAIRFIELD, IL
ZIP 62837
Phone: (618) 842-2125
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S E ILLINOIS COUNSELING CTRS is an addiction (substance use disorder) counselor in Fairfield, IL. S E ILLINOIS COUNSELING CTRS NPI is 1013186568. The provider is registered as an organization entity type.
The provider Other Name Is Wayne Family Counseling Ctr.

The provider's business location address is:

407 N BASIN RD
FAIRFIELD, IL
ZIP 62837-639
Phone: (618) 842-2125
Fax: (618) 842-2126

The provider's authorized official is Glenn Jackson .
The authorized official title is Executive Director and has the following contact phone number (618) 395-4309.

The enumeration date for this NPI number is 2/28/2008 and was last updated on 5/5/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	251S00000X	Community/Behavioral Health		No
2	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	No
3	261QM0850X	Clinic/Center	Adult Mental Health	No
4	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	No
5	101YA0400X	Counselor	Addiction (Substance Use Disorder)	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	=========010	MEDICAID	ILLINOIS
2	=========008	MEDICAID	ILLINOIS
3	IL2222	MEDICARE PIN	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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