Healthcare Provider Details

I. General information

NPI: 1821207309
Provider Name (Legal Business Name): SOUTHWEST FAMILY & CHILDRENS TESTING & THERAPY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 EMILY DRIVE
OFALLON IL
62269
US

IV. Provider business mailing address

PO BOX 339 501 EMILY DRIVE
OFALLON IL
62269
US

V. Phone/Fax

Practice location:
  • Phone: 618-632-7400
  • Fax: 618-632-8376
Mailing address:
  • Phone: 618-632-7400
  • Fax: 618-632-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. PHILIP L ECKERT
Title or Position: EXECUTIVE DIRECTOR
Credential: LCPC
Phone: 618-632-7400