Healthcare Provider Details

I. General information

NPI: 1578801007
Provider Name (Legal Business Name): FIRST STEP COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WHITELAW AVE
WOOD RIVER IL
62095-1911
US

IV. Provider business mailing address

114 WHITELAW AVE
WOOD RIVER IL
62095-1911
US

V. Phone/Fax

Practice location:
  • Phone: 618-251-4225
  • Fax: 618-251-4586
Mailing address:
  • Phone: 618-251-4225
  • Fax: 618-251-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA MCHENRY
Title or Position: DIRECTOR
Credential: MA, MS, LCPC
Phone: 618-251-4225