Provider Demographics
NPI:1780831453
Name:ARROWLEAF
Entity Type:Organization
Organization Name:ARROWLEAF
Other - Org Name:FAMILY COUNSELING CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:COWSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-652-2046
Mailing Address - Street 1:125 NORTH MARKET STREET
Mailing Address - Street 2:PO BOX 759
Mailing Address - City:GOLCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:62938
Mailing Address - Country:US
Mailing Address - Phone:618-683-2461
Mailing Address - Fax:618-683-2461
Practice Address - Street 1:904 VINE STREET
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995
Practice Address - Country:US
Practice Address - Phone:618-658-4047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========013Medicaid