Healthcare Provider Details

I. General information

NPI: 1821972589
Provider Name (Legal Business Name): BERBERICH COUNSELING AND COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10927 UPLAND TERRACE DR
LEBANON IL
62254-2335
US

IV. Provider business mailing address

10927 UPLAND TERRACE DR
LEBANON IL
62254-2335
US

V. Phone/Fax

Practice location:
  • Phone: 618-580-2796
  • Fax:
Mailing address:
  • Phone: 618-580-2796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CORY MATTHEW BERBERICH
Title or Position: PRESIDENT
Credential: MA, LCPC
Phone: 618-580-2796