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General NPI Number Information
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NPI Number | 1285803072
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Entity Type | Organization
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Legal Business Name | COUNSELING FOR A CHANGE
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 70 SANDY PT
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City | GOREVILLE
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State | IL
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Zip | 62939-3122
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Country | US
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Telephone | 618-889-3987
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Fax | 618-351-1419
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Provider Business Mailing Address
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Address Line | 70 SANDY PT
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City | GOREVILLE
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State | IL
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Zip | 62939-3122
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Country | US
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Telephone | 618-889-3987
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Fax | 618-351-1419
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Authorized Official
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Title or Position | OWNER
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Name | MR. DANIEL ANDREW SELOCK
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Credential | MS,CADC,LCPC
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Telephone | 618-889-3987
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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 | 180006639
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License Number State | IL
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