Provider Demographics
NPI:1992867667
Name:SPRINGFIELD FAMILY COUNSELING CENTER
Entity Type:Organization
Organization Name:SPRINGFIELD FAMILY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-494-3727
Mailing Address - Street 1:1700 S SPRING ST
Mailing Address - Street 2:SUITE A1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3961
Mailing Address - Country:US
Mailing Address - Phone:217-494-3727
Mailing Address - Fax:
Practice Address - Street 1:1700 S SPRING ST
Practice Address - Street 2:SUITE A1
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-3961
Practice Address - Country:US
Practice Address - Phone:217-494-3727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150-100211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0008432049OtherBLUE CROSS-BLUE SHIELD