Provider Demographics
NPI:1346452489
Name:EIFERT, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:EIFERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:IL
Mailing Address - Zip Code:62311
Mailing Address - Country:US
Mailing Address - Phone:217-773-3325
Mailing Address - Fax:217-773-2425
Practice Address - Street 1:700 SE CROSS
Practice Address - Street 2:MENTAL HEALTH CENTERS OF WESTERN ILLINOIS
Practice Address - City:MT STERLING
Practice Address - State:IL
Practice Address - Zip Code:62353
Practice Address - Country:US
Practice Address - Phone:217-773-3325
Practice Address - Fax:217-773-2425
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health