Provider Demographics
NPI:1740521285
Name:SOUTHERN ILLINOIS CENTER FOR ART & PLAY THERAPY LLC
Entity type:Organization
Organization Name:SOUTHERN ILLINOIS CENTER FOR ART & PLAY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:ATR-BC, LCPC
Authorized Official - Phone:618-534-3393
Mailing Address - Street 1:105 N EMERALD LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2168
Mailing Address - Country:US
Mailing Address - Phone:618-534-3393
Mailing Address - Fax:618-457-7736
Practice Address - Street 1:105 N EMERALD LN
Practice Address - Street 2:SUITE C
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2168
Practice Address - Country:US
Practice Address - Phone:618-534-3393
Practice Address - Fax:618-457-7736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008512251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health