| Southern Il Institute Of Behavioral Health Pc | |
|
9 Junction Dr W Suite 6 Glen Carbon IL 62034-2931 | |
| (618) 710-4123 | |
| (618) 731-4082 |
| Full Name | Southern Il Institute Of Behavioral Health Pc |
|---|---|
| Speciality | Psychologist |
| Location | 9 Junction Dr W, Glen Carbon, Illinois |
| Authorized Official Name and Position | Tracy Lynn Sashidharan (TREASURER) |
| Authorized Official Contact | 6187104123 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Il Institute Of Behavioral Health Pc Po Box 98 Edwardsville IL 62025-0098 Ph: (618) 710-4123 | Southern Il Institute Of Behavioral Health Pc 9 Junction Dr W Suite 6 Glen Carbon IL 62034-2931 Ph: (618) 710-4123 |
| NPI Number | 1346562881 |
|---|---|
| Provider Enumeration Date | 02/25/2010 |
| Last Update Date | 05/19/2012 |
| Medicare PECOS PAC ID | 8527190206 |
|---|---|
| Medicare Enrollment ID | O20100715000368 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346562881 | NPI | - | NPPES |
| Provider Name | Shannon N Walker |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801020573 PECOS PAC ID: 8224160908 Enrollment ID: I20100715000415 |
| Provider Name | Emily Caroline Mooshegian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609329523 PECOS PAC ID: 9234423898 Enrollment ID: I20160804002715 |
| Provider Name | Rachel L Daly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659969707 PECOS PAC ID: 8022410265 Enrollment ID: I20210712001550 |
| Provider Name | Kimberley M Malloy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437588159 PECOS PAC ID: 1153772249 Enrollment ID: I20240112003719 |
| Provider Name | Leah Rutenberg |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750556841 PECOS PAC ID: 1951679265 Enrollment ID: I20240220001195 |
| Provider Name | Tracy L Sashidharan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013245737 PECOS PAC ID: 0042342727 Enrollment ID: I20240229000866 |
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