Provider Demographics
NPI:1336445030
Name:MIDWEST CLINICAL COUNSELING
Entity Type:Organization
Organization Name:MIDWEST CLINICAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-726-8744
Mailing Address - Street 1:915 S GRAND AVE W
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3642
Mailing Address - Country:US
Mailing Address - Phone:217-726-8744
Mailing Address - Fax:877-721-7028
Practice Address - Street 1:915 S GRAND AVE W
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-3642
Practice Address - Country:US
Practice Address - Phone:217-726-8744
Practice Address - Fax:877-721-7028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty