Provider Demographics
NPI:1326898909
Name:CONFLUENCE INDIVIDUAL AND RELATIONSHIP COUNSELING LLC
Entity type:Organization
Organization Name:CONFLUENCE INDIVIDUAL AND RELATIONSHIP COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW CADC
Authorized Official - Phone:815-222-1679
Mailing Address - Street 1:5005 HONONEGAH RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-8682
Mailing Address - Country:US
Mailing Address - Phone:779-259-4011
Mailing Address - Fax:779-771-6343
Practice Address - Street 1:5005 HONONEGAH RD UNIT 1
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-8682
Practice Address - Country:US
Practice Address - Phone:779-269-4011
Practice Address - Fax:779-771-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)