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 1:4301 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-1279
Mailing Address - Country:US
Mailing Address - Phone:815-222-1679
Mailing Address - Fax:
Practice Address - Street 1:4301 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-1279
Practice Address - Country:US
Practice Address - Phone:815-222-1679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)