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General NPI Number Information
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NPI Number | 1740521285
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS CENTER FOR ART & PLAY THERAPY LLC
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Dates
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Enumeration Date | 03/08/2013
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Last Update Date | 03/08/2013
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Provider Practice Location Address
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Address Line | 105 N EMERALD LN SUITE C
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City | CARBONDALE
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State | IL
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Zip | 62901-2168
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Country | US
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Telephone | 618-534-3393
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Fax | 618-457-7736
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Provider Business Mailing Address
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Address Line | 105 N EMERALD LN SUITE C
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City | CARBONDALE
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State | IL
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Zip | 62901-2168
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Country | US
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Telephone | 618-534-3393
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Fax | 618-457-7736
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | KATHERINE SCHWARTZ
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Credential | ATR-BC, LCPC
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Telephone | 618-534-3393
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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 | 180.008512
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License Number State | IL
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