Provider Demographics
NPI:1346677598
Name:EDITH POHLAND
Entity Type:Organization
Organization Name:EDITH POHLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:POHLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC, LPHA
Authorized Official - Phone:309-687-7760
Mailing Address - Street 1:2011 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-2414
Mailing Address - Country:US
Mailing Address - Phone:309-687-7760
Mailing Address - Fax:
Practice Address - Street 1:2011 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-2414
Practice Address - Country:US
Practice Address - Phone:309-687-7760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004666251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health