Provider Demographics
NPI:1831643147
Name:M. CRAIG COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:M. CRAIG COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LCPC
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-258-6473
Mailing Address - Street 1:300 E WAR MEMORIAL DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-7570
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 E WAR MEMORIAL DR
Practice Address - Street 2:SUITE 306
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-7570
Practice Address - Country:US
Practice Address - Phone:309-692-4193
Practice Address - Fax:309-424-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty