Provider Demographics
NPI:1740279074
Name:INTERFAITH COUNSELING CENTER
Entity type:Organization
Organization Name:INTERFAITH COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN, LCPC, LMFT
Authorized Official - Phone:618-659-1606
Mailing Address - Street 1:205 S MAIN ST
Mailing Address - Street 2:STE. B
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1921
Mailing Address - Country:US
Mailing Address - Phone:618-659-1606
Mailing Address - Fax:314-835-1016
Practice Address - Street 1:205 S MAIN ST
Practice Address - Street 2:STE. B
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1921
Practice Address - Country:US
Practice Address - Phone:618-659-1606
Practice Address - Fax:314-835-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable