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General NPI Number Information
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NPI Number | 1265618615
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Entity Type | Organization
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Legal Business Name | JMP COUNSELING AND TUTORING SERVICES, LLC
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 109 N. MAIN ST.
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City | ST. JOSEPH
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State | IL
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Zip | 61873
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Country | US
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Telephone | 217-469-9300
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Fax | 217-469-9301
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Provider Business Mailing Address
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Address Line | 109 N. MAIN ST.
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City | ST. JOSEPH
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State | IL
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Zip | 61873
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Country | US
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Telephone | 217-469-9300
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Fax | 217-469-9301
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | GINA K. JOHNSON
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Credential | MSW, LCSW
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Telephone | 309-883-1439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | IL
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Taxonomy #2
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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 | IL
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