Provider Demographics
NPI:1265663694
Name:PAM HERRICK COUNSELING, S.C.
Entity Type:Organization
Organization Name:PAM HERRICK COUNSELING, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-543-0043
Mailing Address - Street 1:314 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAVANA
Mailing Address - State:IL
Mailing Address - Zip Code:62644-1140
Mailing Address - Country:US
Mailing Address - Phone:309-543-0043
Mailing Address - Fax:309-543-0043
Practice Address - Street 1:314 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAVANA
Practice Address - State:IL
Practice Address - Zip Code:62644-1140
Practice Address - Country:US
Practice Address - Phone:309-543-0043
Practice Address - Fax:309-543-0043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAM HERRICK COUNSELING, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty