Provider Demographics
NPI:1386184315
Name:CONNECTIONS FAMILY COUNSELING, LLC
Entity Type:Organization
Organization Name:CONNECTIONS FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDER LEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-593-3145
Mailing Address - Street 1:822 STATE ST
Mailing Address - Street 2:SUITE # 9
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4961
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:822 STATE ST
Practice Address - Street 2:SUITE # 9
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4961
Practice Address - Country:US
Practice Address - Phone:217-231-1413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008138101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty