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General NPI Number Information
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NPI Number | 1548159742
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Entity Type | Organization
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Legal Business Name | REAL REACH MENTAL HEALTH SERVICE, LLC
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 1 REDBUD LN
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City | MURPHYSBORO
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State | IL
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Zip | 62966-6551
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Country | US
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Telephone | 618-534-0767
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Fax |
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Provider Business Mailing Address
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Address Line | 4346 COUNCIL CIR
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City | JACKSON
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State | MS
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Zip | 39206-5819
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Country | US
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Telephone | 618-534-0767
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MS. ANDREA DAWN COULTER
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Credential | LCPC
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Telephone | 312-625-1742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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