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NPI Code Detail

MEDICARE: PROFESSIONAL SUPPORTIVE SOLUTION THERAPY

MEDICARE: PROFESSIONAL SUPPORTIVE SOLUTION THERAPY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency178.011045IL

General Provider Information

NPI Number : 1295107563
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL SUPPORTIVE SOLUTION THERAPY
Provider Business Mailing Address
First Line : 6400 W MAIN ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62223-3806
Country : US
Telephone Number : 314-786-2870
Fax Number :
Provider Business Practice Location Address
First Line : 6400 W MAIN ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62223-3806
Country : US
Telephone Number : 314-786-2870
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. APRIL DAWN JONES
Credential : LPC
Telephone Number : 618-581-3751
Provider Enumeration Date : 10/27/2015
Last Update Date : 10/27/2015

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Directions to “PROFESSIONAL SUPPORTIVE SOLUTION THERAPY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.