Provider Demographics
NPI:1851160204
Name:SISU COUNSELING CENTER, PLLC
Entity Type:Organization
Organization Name:SISU COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:SARAH
Authorized Official - Last Name:KEEMLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-716-5764
Mailing Address - Street 1:3913 15TH STREET D UNIT A 1/2
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7267
Mailing Address - Country:US
Mailing Address - Phone:309-716-5764
Mailing Address - Fax:
Practice Address - Street 1:3913 15TH STREET D UNIT A1
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7267
Practice Address - Country:US
Practice Address - Phone:309-581-1585
Practice Address - Fax:309-581-1583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty