Healthcare Provider Details

I. General information

NPI: 1427503788
Provider Name (Legal Business Name): EAST DUBUQUE COUNSELING LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 SIDNEY ST 3RD FLOOR
EAST DUBUQUE IL
61025-1175
US

IV. Provider business mailing address

430 SIDNEY ST 3RD FLOOR
EAST DUBUQUE IL
61025-1175
US

V. Phone/Fax

Practice location:
  • Phone: 815-306-8089
  • Fax:
Mailing address:
  • Phone: 815-306-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number180.003386
License Number StateIL

VIII. Authorized Official

Name: MRS. DIEUNN SYNNTHIEA SERRIE MUSSER
Title or Position: PRESIDENT
Credential: LCPC
Phone: 815-306-8089