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General NPI Number Information
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NPI Number | 1871893255
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Entity Type | Organization
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Legal Business Name | SALEM COUNSELING CENTER, P.C.
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 03/23/2015
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Provider Practice Location Address
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Address Line | 200 N PEARL ST
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City | SALEM
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State | IL
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Zip | 62881-1532
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Country | US
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Telephone | 618-548-3435
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Fax | 618-548-3435
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Provider Business Mailing Address
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Address Line | 200 N PEARL ST
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City | SALEM
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State | IL
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Zip | 62881-1532
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Country | US
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Telephone | 618-548-3435
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Fax | 618-548-3435
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Authorized Official
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Title or Position | COUNSELOR
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Name | MRS. JULIE A. HOLLAND
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Credential | NCC, LCPC
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Telephone | 618-548-3435
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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 | 180.007478
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License Number State | IL
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