Healthcare Provider Details

I. General information

NPI: 1023948478
Provider Name (Legal Business Name): PRAIRIE ROSE COUNSELING AND CONSULTING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8124 STATE ROUTE 140
EDWARDSVILLE IL
62025-6114
US

IV. Provider business mailing address

8124 STATE ROUTE 140
EDWARDSVILLE IL
62025-6114
US

V. Phone/Fax

Practice location:
  • Phone: 567-337-9937
  • Fax:
Mailing address:
  • Phone: 567-337-9937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE MARIE COOPER
Title or Position: OWNER/THERAPIST
Credential: LCPC, LPCC, LPC, LM
Phone: 567-337-9937