Provider Demographics
NPI:1861769184
Name:COUNSELING ASSOCIATES OF SOUTHERN ILLINOIS
Entity type:Organization
Organization Name:COUNSELING ASSOCIATES OF SOUTHERN ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-622-2579
Mailing Address - Street 1:1669 WINDHAM WAY STE B
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3072
Mailing Address - Country:US
Mailing Address - Phone:618-622-2579
Mailing Address - Fax:618-624-8506
Practice Address - Street 1:1669 WINDHAM WAY STE B
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3072
Practice Address - Country:US
Practice Address - Phone:618-622-2579
Practice Address - Fax:618-624-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007978101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO732-136OtherHEALTHLINK
IL0823180OtherBLUE CROSS