| Southern Illinois Therapy Services, Pllc | |
|
205 Bailey Ln Ste 3w Benton IL 62812-1921 | |
| (618) 218-4544 | |
| Not Available |
| Full Name | Southern Illinois Therapy Services, Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 205 Bailey Ln Ste 3w, Benton, Illinois |
| Authorized Official Name and Position | Samantha Ann Kimble (OWNER/LCSW) |
| Authorized Official Contact | 6182184544 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois Therapy Services, Pllc 205 Bailey Ln Ste 3w Benton IL 62812-1921 Ph: (618) 218-4544 | Southern Illinois Therapy Services, Pllc 205 Bailey Ln Ste 3w Benton IL 62812-1921 Ph: (618) 218-4544 |
| NPI Number | 1891435657 |
|---|---|
| Provider Enumeration Date | 03/30/2022 |
| Last Update Date | 04/18/2022 |
| Certification Date | 04/18/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891435657 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |