Provider Demographics
NPI:1356726707
Name:FAMILY COUNSELING CENTER
Entity type:Organization
Organization Name:FAMILY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-658-2611
Mailing Address - Street 1:408 E VINE ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995-1612
Mailing Address - Country:US
Mailing Address - Phone:618-658-2611
Mailing Address - Fax:
Practice Address - Street 1:408 E VINE ST
Practice Address - Street 2:SAME
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1612
Practice Address - Country:US
Practice Address - Phone:618-658-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health