| Community Life Counseling Center | |
|
473 W Harrison Rd Murphysboro IL 62966-4782 | |
| (618) 867-2222 | |
| (618) 687-3102 |
| Full Name | Community Life Counseling Center |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 473 W Harrison Rd, Murphysboro, Illinois |
| Authorized Official Name and Position | Philip C Nordstrom (REGISTERED AGENT) |
| Authorized Official Contact | 6188672222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Life Counseling Center 473 W Harrison Rd Murphysboro IL 62966-4782 Ph: (618) 867-2222 | Community Life Counseling Center 473 W Harrison Rd Murphysboro IL 62966-4782 Ph: (618) 867-2222 |
| NPI Number | 1336292135 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336292135 | NPI | - | NPPES |
| 03932042 | Other | IL | BLUE CROSS BLUE SHIELD IL |
| 122970 | Other | IL | HEALTHALLIANCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149-0100100 (Illinois) | Primary |
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