Healthcare Provider Details

I. General information

NPI: 1134185713
Provider Name (Legal Business Name): MASSAC COUNTY MENTAL HEALTH & FAMILY COUNSELING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W FIFTH ST
METROPOLIS IL
62960
US

IV. Provider business mailing address

206 W FIFTH ST
METROPOLIS IL
62960
US

V. Phone/Fax

Practice location:
  • Phone: 618-524-9368
  • Fax: 618-524-9551
Mailing address:
  • Phone: 618-524-9368
  • Fax: 618-524-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. YVONNE J RATH
Title or Position: EXECUTIVE DIRECTOR
Credential: PH D
Phone: 618-524-9368