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General NPI Number Information
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NPI Number | 1588437636
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Entity Type | Organization
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Legal Business Name | MIDWEST ADVANCED BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 16 EMERALD TER
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City | SWANSEA
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State | IL
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Zip | 62226-2321
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Country | US
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Telephone | 618-558-9035
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Fax |
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Provider Business Mailing Address
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Address Line | 904 STONE BRIAR DR
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City | O FALLON
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State | IL
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Zip | 62269-6981
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Country | US
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Telephone | 618-558-9035
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RACHEL KENT
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Credential |
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Telephone | 618-558-9035
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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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