Healthcare Provider Details

I. General information

NPI: 1063709228
Provider Name (Legal Business Name): UNION COUNTY COUNSELING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W VIENNA ST
ANNA IL
62906
US

IV. Provider business mailing address

PO BOX 548
ANNA IL
62906-0548
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-8415
  • Fax: 618-833-2911
Mailing address:
  • Phone: 618-833-8551
  • Fax: 618-833-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DANUTA DEL RIO
Title or Position: EXECUTIVE DIRECTOR
Credential: LCPC
Phone: 618-833-8551