Counseling For A Change | |
70 Sandy Pt Goreville IL 62939-3122 | |
(618) 889-3987 | |
(618) 351-1419 |
Full Name | Counseling For A Change |
---|---|
Speciality | Counselor - Professional |
Location | 70 Sandy Pt, Goreville, Illinois |
Authorized Official Name and Position | Daniel Andrew Selock (OWNER) |
Authorized Official Contact | 6188893987 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Counseling For A Change 70 Sandy Pt Goreville IL 62939-3122 Ph: (618) 889-3987 | Counseling For A Change 70 Sandy Pt Goreville IL 62939-3122 Ph: (618) 889-3987 |
NPI Number | 1285803072 |
---|---|
Provider Enumeration Date | 02/26/2008 |
Last Update Date | 01/08/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285803072 | NPI | - | NPPES |
180006639 | Other | IL | STATE LICENSE, LCPC |
11826508 | Other | IL | CAQH |
03932079 | Other | IL | BLUE CROSS BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | 180006639 (Illinois) | Primary |