Healthcare Provider Details

I. General information

NPI: 1255525507
Provider Name (Legal Business Name): ROBERT GEORGE READING LCPC, NCC, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N KNOXVILLE AVE SUITE 215
PEORIA IL
61614-5098
US

IV. Provider business mailing address

5401 N KNOXVILLE AVE SUITE 215
PEORIA IL
61614-5098
US

V. Phone/Fax

Practice location:
  • Phone: 309-689-0044
  • Fax: 309-689-0055
Mailing address:
  • Phone: 309-689-0044
  • Fax: 309-689-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12855
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.003858
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.003858
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: