Provider Demographics
NPI:1265618615
Name:JMP COUNSELING AND TUTORING SERVICES, LLC
Entity type:Organization
Organization Name:JMP COUNSELING AND TUTORING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:309-883-1439
Mailing Address - Street 1:109 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:ST. JOSEPH
Mailing Address - State:IL
Mailing Address - Zip Code:61873
Mailing Address - Country:US
Mailing Address - Phone:217-469-9300
Mailing Address - Fax:217-469-9301
Practice Address - Street 1:109 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:ST. JOSEPH
Practice Address - State:IL
Practice Address - Zip Code:61873
Practice Address - Country:US
Practice Address - Phone:217-469-9300
Practice Address - Fax:217-469-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty