Healthcare Provider Details

I. General information

NPI: 1063020071
Provider Name (Legal Business Name): PSCHERTZ COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 N UNIVERSITY ST STE 101
PEORIA IL
61614-4763
US

IV. Provider business mailing address

5016 N UNIVERSITY ST STE 101
PEORIA IL
61614-4763
US

V. Phone/Fax

Practice location:
  • Phone: 309-373-0153
  • Fax:
Mailing address:
  • Phone: 309-373-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. PHIL SCHERTZ
Title or Position: OWNER
Credential: LCPC
Phone: 309-370-1539