Healthcare Provider Details

I. General information

NPI: 1396876140
Provider Name (Legal Business Name): COUNSELING & FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SW WASHINGTON ST
PEORIA IL
61602-1417
US

IV. Provider business mailing address

330 SW WASHINGTON ST
PEORIA IL
61602-1406
US

V. Phone/Fax

Practice location:
  • Phone: 309-676-2400
  • Fax:
Mailing address:
  • Phone: 309-676-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number180-003685
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number180-003685
License Number StateIL

VIII. Authorized Official

Name: ANN R LADING-FERGUSON
Title or Position: CEO
Credential:
Phone: 309-676-2400