Healthcare Provider Details

I. General information

NPI: 1538177373
Provider Name (Legal Business Name): UNION COUNTY COUNSELING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SOUTH STREET
ANNA IL
62906
US

IV. Provider business mailing address

PO BOX 548
ANNA IL
62906-0548
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-8551
  • Fax: 618-833-2911
Mailing address:
  • Phone: 618-833-8551
  • Fax: 618-833-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JENNIFER TRAVELSTEAD
Title or Position: ASST. FISCAL MANAGER
Credential:
Phone: 618-833-8551