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General NPI Number Information
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NPI Number | 1457658189
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Entity Type | Organization
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Legal Business Name | LIBERTY COUNSELING CENTER, INC
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 1429 S MAIN ST SUITE A
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City | JACKSONVILLE
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State | IL
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Zip | 62650-3476
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Country | US
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Telephone | 217-479-0691
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Fax | 217-478-2060
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Provider Business Mailing Address
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Address Line | 1429 S MAIN ST SUITE A
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City | JACKSONVILLE
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State | IL
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Zip | 62650-3476
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Country | US
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Telephone | 217-479-0691
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Fax | 217-478-2060
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | MRS. SANDRA K EYMAN
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Credential | MS,CADC,MISAII
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Telephone | 217-479-0691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A-7302-0001-A
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License Number State | IL
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