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General NPI Number Information
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NPI Number | 1740279074
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Entity Type | Organization
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Legal Business Name | INTERFAITH COUNSELING CENTER
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 205 S MAIN ST STE. B
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-1921
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Country | US
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Telephone | 618-659-1606
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Fax | 314-835-1016
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Provider Business Mailing Address
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Address Line | 205 S MAIN ST STE. B
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-1921
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Country | US
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Telephone | 618-659-1606
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Fax | 314-835-1016
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Authorized Official
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Title or Position | DIRECTOR/PRESIDENT
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Name | DR. BRIAN GLEN STOREY
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Credential | D.MIN., LCPC, LMFT
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Telephone | 618-659-1606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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