Provider Demographics
NPI:1922287887
Name:COUNSELING CLINIC LTD.
Entity Type:Organization
Organization Name:COUNSELING CLINIC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-659-9111
Mailing Address - Street 1:871 S ARBOR VITAE SUITE 003
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3400
Mailing Address - Country:US
Mailing Address - Phone:618-659-9111
Mailing Address - Fax:618-692-9111
Practice Address - Street 1:871 S ARBOR VITAE STE 3
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3400
Practice Address - Country:US
Practice Address - Phone:618-659-9111
Practice Address - Fax:618-692-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty