Healthcare Provider Details

I. General information

NPI: 1427520352
Provider Name (Legal Business Name): CREATING PEACE OF MIND COGNITIVE BEHAVIORAL HEALTH-LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 N ILLINOIS ST STE D
SWANSEA IL
62226-1967
US

IV. Provider business mailing address

650 HILLSBORO AVE
EDWARDSVILLE IL
62025-1865
US

V. Phone/Fax

Practice location:
  • Phone: 618-520-1764
  • Fax: 618-825-9400
Mailing address:
  • Phone: 618-520-1764
  • Fax: 618-258-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBIN L DALSKE
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 618-408-1256