Healthcare Provider Details

I. General information

NPI: 1851792691
Provider Name (Legal Business Name): ABC COUNSELING & FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7820 N UNIVERSITY ST SUITE 101
PEORIA IL
61614-1220
US

IV. Provider business mailing address

705 E LINCOLN ST STE 303
NORMAL IL
61761-6406
US

V. Phone/Fax

Practice location:
  • Phone: 309-689-2990
  • Fax:
Mailing address:
  • Phone: 309-451-9495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: LYNN WILLARD
Title or Position: EXECUTIVE DIRECTOR
Credential: LCPC, LCSW
Phone: 309-451-9495