S E ILLINOIS COUNSELING CTRS (NPI# 1013186568) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013186568 |
| Entity Type | Organization |
| Organization Name | S E ILLINOIS COUNSELING CTRS |
| Other Organization Name | WAYNE FAMILY COUNSELING CTR |
| Practice Address |
407 N Basin Rd Fairfield IL 62837-9639 |
| Mailing Address |
Po Box M 504 Micah Drive Olney IL 62450-0913 |
| Practice Telephone | 6188422125 |
| Practice Fax Number | 6188422126 |
| Mailing Telephone | 6183954306 |
| Mailing Fax Number | 6183954507 |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2016-05-05 |
| Authorized Official Name | MR. GLENN JACKSON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6183954309 |
| Authorized Official Credential | M. DIV., LSW, LC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| WAYNE FAMILY COUNSELING CTR | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750550208 | S E Illinois Counseling Ctrs | Clinic/Center | 204 W Highland Ave, Robinson, IL 62454-1710 | 2008-02-28 |
| 1205005758 | S E Illinois Counseling Ctrs | Community/Behavioral Health | 254 S 5th St, Albion, IL 62806-1121 | 2008-02-28 |
| Street Address |
407 N BASIN RD |
| City | FAIRFIELD |
| State | IL |
| Zip Code | 62837-9639 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952589830 | South Eastern Illinois Counseling Center Inc | Clinic/Center | 407 N Basin Rd, Fairfield, IL 62837-9639 | 2008-02-04 |
| 1750909628 | Brian Frank Vahl | Counselor | 407 N Basin Rd, Fairfield, IL 62837-9639 | 2020-07-08 |
| 1376003202 | Rosella Leeann Book | Counselor | 407 N Basin Rd, Fairfield, IL 62837-9639 | 2019-03-25 |
| 1699242131 | Egyptian Health Department | Community/Behavioral Health | 407 N Basin Rd, Fairfield, IL 62837-9639 | 2018-11-01 |
| 1689141145 | Egyptian Health Department | Community/Behavioral Health | 407 N Basin Rd, Fairfield, IL 62837-9639 | 2018-11-01 |
| 1306349329 | Renae Robertson | Counselor | 407 N Basin Rd, Fairfield, IL 62837-9639 | 2018-03-15 |
| 1235598855 | Shari Winter | Counselor | 407 N Basin Rd, Fairfield, IL 62837-9639 | 2016-02-11 |
| 1780053348 | Makenzie Baker X | Counselor | 407 N Basin Rd, Fairfield, IL 62837-9639 | 2015-09-24 |
| 1881006369 | Allissa Keoughan | Counselor | 407 N Basin Rd, Fairfield, IL 62837-9639 | 2014-06-02 |
| 1033496260 | Jeneva Carron | Counselor | 407 N Basin Rd, Fairfield, IL 62837-9639 | 2011-11-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881294619 | Katelyn Atteberry | Pharmacist | 150 Commerce Drive, Fairfield, IL 62837 | 2020-10-30 |
| 1265894521 | Rebecca August | Social Worker | 506 Nw 9th St, Fairfield, IL 62837 | 2016-03-25 |
| 1063814259 | Kathie L Hill | Social Worker | 303 Nw 11th St., Fairfield Memorial Hospital, Fairfield, IL 62837 | 2014-09-19 |
| 1912206731 | Way-fair Nursing and Rehabilitation Center, LLC | Skilled Nursing Facility | 305 Northwest 11th Street, Fairfield, IL 62837 | 2011-03-18 |
| 1063600773 | Alvin Ewing | Counselor | 407 N. Basin Road, Fairfield, IL 62837 | 2007-10-09 |
| 1417145129 | Gilbert Tennyson | Counselor | 407 North Basin Rd, Fairfield, IL 62837 | 2007-10-09 |
| 1972791689 | Clint Harvey | Counselor | 407 North Basin Road, Fairfield, IL 62837 | 2007-10-09 |
| 1770789778 | Fairfield Estates, LLC | Point of Service | 315 North Market Street, Fairfield, IL 62837 | 2007-06-26 |
| 1346382207 | Robert E Lowry | Counselor | 407 N Basin Rd., Fairfield, IL 62837 | 2007-02-13 |
| 1790840825 | Bradley D Kramer | Dentist | 301 Nw 11th Street, Suite 212, Fairfield, IL 62837 | 2006-12-27 |
| Find all providers in zip 62837 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700411386 | Darren Hailey | Counselor | 72 Villa Cir, Fairfield, CA 94533-2523 | 2020-03-04 |
| 1013567270 | Asia Robinson | Counselor | 1165 Dove Way, Fairfield, CA 94533-2542 | 2019-09-18 |
| 1689220477 | Carl Leonard Fessenden | Counselor | 1974 Winchester Pl, Fairfield, CA 94533-3618 | 2019-08-16 |
| 1598262677 | Jason Michael Levline | Counselor | 5266 Charlene Ave, Fairfield, OH 45014-1535 | 2018-04-06 |
| 1497285084 | Beth A. Bronfman | Counselor | 87 Fairfield Rd, Fairfield, NJ 07004-2546 | 2017-06-15 |
| 1588191290 | Kirk D. Condon | Counselor | 201 South 23rd, Fairfield, IA 52556 | 2017-05-12 |
| 1205373537 | Samuel E Ghee IIi | Counselor | Decoach Rehabilitation Center, 6570 Sosna Drive, Fairfield, OH 45014 | 2017-01-25 |
| 1730639329 | Jonathon Grogan | Counselor | 2480 Hilborn Rd, Fairfield, CA 94534-1856 | 2016-10-07 |
| 1295119196 | Sara Faye Jones | Counselor | 745 Ohio St Apt 2, Fairfield, CA 94533-6222 | 2015-07-10 |
| 1205242583 | Amy Lynn Davis | Counselor | 620 Julmar Cir, Fairfield, CA 94534-4214 | 2014-07-07 |
| Find all providers in FAIRFIELD | ||||
Please comment or provide details below to improve the information on S E ILLINOIS COUNSELING CTRS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.