SOUTH EASTERN ILLINOIS COUNSELING CENTER INC NPI 1407034382

NPI Information

NPI: 1407034382
Provider Name: SOUTH EASTERN ILLINOIS COUNSELING CENTER INC

Other Name: WABASH FAMILY COUNSELING CENTER

Classification: Counselor - 101YM0800X
Entity Type: Organization

Specialization: Mental Health

Address:
602 E 5TH ST
MOUNT CARMEL, IL
ZIP 62863
Phone: (618) 262-7473
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SOUTH EASTERN ILLINOIS COUNSELING CENTER INC is a mental health counselor in Mount Carmel, IL. SOUTH EASTERN ILLINOIS COUNSELING CENTER INC NPI is 1407034382. The provider is registered as an organization entity type.
The provider Other Name Is Wabash Family Counseling Center.

The provider's business location address is:

602 E 5TH ST
MOUNT CARMEL, IL
ZIP 62863-152
Phone: (618) 262-7473
Fax: (618) 262-8810

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 2/4/2008 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	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	No
2	101Y00000X	Counselor		No
3	101YA0400X	Counselor	Addiction (Substance Use Disorder)	No
4	101YP2500X	Counselor	Professional	No
5	101YM0800X	Counselor	Mental Health	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	=========002	MEDICAID	ILLINOIS
2	=========011	MEDICAID	ILLINOIS
3	IL2222	MEDICARE UPIN	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: 5/5/2024

NPI Synchronization or Removal

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