ITIC SUPPORT SERVICES INC (NPI# 1164929055) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164929055 |
| Entity Type | Organization |
| Organization Name | ITIC SUPPORT SERVICES INC |
| Other Organization Name | PREFERRED BEHAVIORAL HEALTH |
| Practice Address |
141 Market Pl Ste 100 Fairview Heights IL 62208 |
| Mailing Address |
141 Market Pl Ste 100 Fairview Heights IL 62208-2034 |
| Practice Telephone | 6183984226 |
| Practice Fax Number | 6183981759 |
| Mailing Telephone | 3142385260 |
| Mailing Fax Number | 6183981759 |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2019-09-13 |
| Authorized Official Name | MR. RYAN MORRIS (PRESIDENT) |
| Authorized Official Telephone | 3142385260 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 1164929055 | 05 |
| Other Name | Type Code |
|---|---|
| PREFERRED BEHAVIORAL HEALTH | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 125 N Ruby Ln, Fairview Heights, IL 622081926 | 3148218055 | 3148211833 |
| 141 Market Pl Ste 100, Fairview Heights, IL 62208 | 6183984226 | 6183981759 |
| Street Address |
141 MARKET PL STE 100 |
| City | FAIRVIEW HEIGHTS |
| State | IL |
| Zip Code | 62208 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962014472 | Preferred Behavioral Health Mso, Inc. | Counselor | 141 Market Pl Ste 100, Fairview Heights, IL 62208-2089 | 2020-08-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740829647 | Stephanie Lynn Arzavala-reed | Counselor | 8.5 Canty Lane, Fairview Heights, IL 62208 | 2019-12-26 |
| 1649822156 | Preferred Behavioral Health | Community/Behavioral Health | 141 Market Place Drive, Suite 100, Fairview Heights, IL 62208 | 2019-07-15 |
| 1023525102 | Karen E. Reinacher | Speech-Language Pathologist | 21 Circle Dr., Fairview Heights, IL 62208 | 2018-01-10 |
| 1316465297 | Rachel Moser | Behavioral Analyst | 9510 St. Clair Ave, Fairview Heights, IL 62208 | 2017-08-31 |
| 1952826471 | Tomika Eiland | Social Worker | 413 David Dr, Fairview Heights, IL 62208 | 2017-08-05 |
| 1194113852 | Rachel Logan | Social Worker | 10850 Lincoln Trail, Suite 16 #3, Fairview Heights, IL 62208 | 2015-01-05 |
| 1255746715 | Center for Advanced Medicine LLC | Internal Medicine | 5036 N Illinois St, Suite 1, Fairview Heights, IL 62208 | 2014-06-24 |
| 1033463393 | Katherine Johnson I | Physical Therapy Assistant | 320 N Ruby Ln, Fairview Heights, IL 62208 | 2012-11-07 |
| 1508118779 | Nicole Kovacic | Physical Therapy Assistant | 5501 Perrin Drive, Fairview Heights, IL 62208 | 2012-10-11 |
| 1104140821 | Lindsay Wilson | Physician Assistant | 5031 N. Illinois St, O'fallon, IL 62208 | 2010-03-24 |
| Find all providers in zip 62208 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386292571 | Tms Neurohealth Illinois Pllc | Psychiatry & Neurology | 303 Fountains Pkwy Ste 200, Fairview Heights, IL 62208-2074 | 2019-08-30 |
| 1427103860 | Vettikompil Jose Thomas | Psychiatry & Neurology | 10111 Lincoln Trl, Fairview Heights, IL 62208-1825 | 2007-01-24 |
| 1992770580 | Warren J Fournier II | Psychiatry & Neurology | 125 N Ruby Ln, Fairview Heights, IL 62208-1926 | 2006-02-17 |
| 1972074516 | Itic Support Services Group LLC | Psychiatry & Neurology | 141 Market Pl, Fairview Heights, IL 62208-2034 | 2018-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346840659 | Amelia Mari Merz | Psychiatry & Neurology | 1101 Lake St Ste 201b, Oak Park, IL 60301-1046 | 2020-10-27 |
| 1063024925 | Mindful Psychiatric Care LLC | Psychiatry & Neurology | 120 E Ogden Ave Ste 101, Hinsdale, IL 60521-3892 | 2020-08-20 |
| 1053921296 | Healing Hands Resource Center | Psychiatry & Neurology | 6607 W Main St, Belleville, IL 62223-3025 | 2020-08-03 |
| 1144848086 | Zachary A Kordik Md PC | Psychiatry & Neurology | 25 E Washington St Ste 904, Chicago, IL 60602-1715 | 2020-07-07 |
| 1629694278 | Montes Psychiatric Center, P.C. | Psychiatry & Neurology | 717 Trent Ln, Loves Park, IL 61111-8956 | 2020-06-19 |
| 1659996767 | Bluesky Telepsych | Psychiatry & Neurology | 4753 N Broadway St Ste 910, Chicago, IL 60640-4991 | 2020-06-15 |
| 1164047833 | Advanced Psychiatry Clinics, S.c. | Psychiatry & Neurology | 5519 N Cumberland Ave Ste 1016, Chicago, IL 60656-1480 | 2020-06-09 |
| 1326661802 | Psychmed Clinic Inc | Psychiatry & Neurology | 2159 W Madison St, Chicago, IL 60612-2307 | 2020-05-19 |
| 1467074534 | Holmes Psychiatry LLC | Psychiatry & Neurology | 2027 W Division St # 144, Chicago, IL 60622-9024 | 2020-05-12 |
| 1902434947 | Saadiya Jabbar | Psychiatry & Neurology | Loyola University Medical Center, Building 105, Suite 1940, Maywood, IL 60153 | 2020-03-27 |
| Find all providers with the same taxonomy | ||||
| City | FAIRVIEW HEIGHTS |
| Zip Code | 62208 |
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| 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.