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General NPI Number Information
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NPI Number | 1104419365
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Entity Type | Organization
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Legal Business Name | COPING WITH CHOICES THERAPY GROUP LLC
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 1151 BOULDER CREEK DRIVE APT 104
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City | O FALLON
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State | IL
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Zip | 62269-0079
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Country | US
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Telephone | 618-825-8173
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Fax |
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Provider Business Mailing Address
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Address Line | 4020 GREEN MOUNT CROSSING DR STE 108
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City | O FALLON
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State | IL
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Zip | 62269-7287
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Country | US
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Telephone | 618-825-8173
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YVONNE SUZETTE GATES
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Credential |
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Telephone | 618-825-8173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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