Healthcare Provider Details

I. General information

NPI: 1043631351
Provider Name (Legal Business Name): THERAPEUTIC, EDUCATION, AND CAREER SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2014
Last Update Date: 04/29/2022
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 W DE YOUNG ST STE 203 C
MARION IL
62959-6295
US

IV. Provider business mailing address

4505 W DEYOUNG ST STE 203C
MARION IL
62959-5899
US

V. Phone/Fax

Practice location:
  • Phone: 618-292-1663
  • Fax: 618-846-4381
Mailing address:
  • Phone: 618-292-1663
  • Fax: 844-270-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: EVONNE LANAE STEPHENSON
Title or Position: DIRECTOR
Credential: LCPC
Phone: 618-292-1663