Healthcare Provider Details

I. General information

NPI: 1851451983
Provider Name (Legal Business Name): MURPHYSOBORO COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 MULBERRY ST
MURPHYSBORO IL
62966-2666
US

IV. Provider business mailing address

608 MULBERRY ST
MURPHYSBORO IL
62966-2666
US

V. Phone/Fax

Practice location:
  • Phone: 618-687-5353
  • Fax: 618-687-5077
Mailing address:
  • Phone: 618-687-5353
  • Fax: 618-687-5077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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 TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name: DIANE KAYE DAVIS
Title or Position: PRESIDENT
Credential: MSED, NCC, LCPC
Phone: 618-687-5353