Provider Demographics
NPI:1003080144
Name:DWYER-ELIAS COUNSELING AND THERAPY, P.C.
Entity Type:Organization
Organization Name:DWYER-ELIAS COUNSELING AND THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:DWYER-ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LISW
Authorized Official - Phone:309-788-1050
Mailing Address - Street 1:2631 FARNAM ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-1809
Mailing Address - Country:US
Mailing Address - Phone:563-326-4881
Mailing Address - Fax:
Practice Address - Street 1:1800 3RD AVE
Practice Address - Street 2:SUITE 516
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8026
Practice Address - Country:US
Practice Address - Phone:309-788-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty