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General NPI Number Information
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NPI Number | 1699168161
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Entity Type | Organization
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Legal Business Name | TS ONSITE MENTAL HEALTH
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 14376 ALLEN RD
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City | HERRIN
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State | IL
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Zip | 62948-6447
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Country | US
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Telephone | 618-889-0901
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Fax |
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Provider Business Mailing Address
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Address Line | 14376 ALLEN RD
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City | HERRIN
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State | IL
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Zip | 62948-6447
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Country | US
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Telephone | 618-889-0901
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MISS STACIE CARR
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Credential | MSW, LCSW
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Telephone | 618-335-7364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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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 |
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