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General NPI Number Information
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NPI Number | 1861769184
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Entity Type | Organization
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Legal Business Name | COUNSELING ASSOCIATES OF SOUTHERN ILLINOIS
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 1669 WINDHAM WAY STE B
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City | O FALLON
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State | IL
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Zip | 62269-3072
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Country | US
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Telephone | 618-622-2579
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Fax | 618-624-8506
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Provider Business Mailing Address
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Address Line | 1669 WINDHAM WAY STE B
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City | O FALLON
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State | IL
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Zip | 62269-3072
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Country | US
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Telephone | 618-622-2579
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Fax | 618-624-8506
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Authorized Official
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Title or Position | PARTNER
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Name | SHERI MILLER
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Credential |
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Telephone | 618-622-2579
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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 | 180.007978
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License Number State | IL
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