| 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 |