Healthcare Provider Details

I. General information

NPI: 1962668798
Provider Name (Legal Business Name): JW COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 TAMARACH DR
EDWARDSVILLE IL
62025-5250
US

IV. Provider business mailing address

643 TAMARACH DR
EDWARDSVILLE IL
62025-5250
US

V. Phone/Fax

Practice location:
  • Phone: 618-637-9030
  • Fax:
Mailing address:
  • Phone: 618-637-9030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number02550873
License Number StateIL

VIII. Authorized Official

Name: MS. JEANNIE LYNN WARREN
Title or Position: MANAGER
Credential: LCPC
Phone: 618-637-9030