Provider Demographics
NPI:1720368608
Name:FAMILY COUNSELING CENTER INC
Entity Type:Organization
Organization Name:FAMILY COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPUTER BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-658-2611
Mailing Address - Street 1:125 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GOLCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:62938-1136
Mailing Address - Country:US
Mailing Address - Phone:618-683-2461
Mailing Address - Fax:
Practice Address - Street 1:125 N MARKET ST
Practice Address - Street 2:
Practice Address - City:GOLCONDA
Practice Address - State:IL
Practice Address - Zip Code:62938-1136
Practice Address - Country:US
Practice Address - Phone:618-683-2461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04055261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT5DDRTQE99C0OtherHFS ID NUMBER