MEDICARE: LIBERTY COUNSELING CENTER, INC

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
1	251S00000X	Community/Behavioral Health Agency	A-7302-0001-A	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457658189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY COUNSELING CENTER, INC

Provider Business Mailing Address
First Line	:	1429 S MAIN ST
Second Line	:	SUITE A
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-3476
Country	:	US
Telephone Number	:	217-479-0691
Fax Number	:	217-478-2060

Provider Business Practice Location Address
First Line	:	1429 S MAIN ST
Second Line	:	SUITE A
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-3476
Country	:	US
Telephone Number	:	217-479-0691
Fax Number	:	217-478-2060

Authorized Official
Title or Position	:	PRESIDENT/DIRECTOR
Name	:	MRS. SANDRA K EYMAN
Credential	:	MS,CADC,MISAII
Telephone Number	:	217-479-0691

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	02/15/2011

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Directions to “LIBERTY COUNSELING CENTER, INC ” Practice Location

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