PREFERRED BEHAVIORAL HEALTH MSO, INC. (NPI# 1962014472) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1962014472 |
Entity Type | Organization |
Organization Name | PREFERRED BEHAVIORAL HEALTH MSO, INC. |
Practice Address |
141 Market Pl Ste 100 Fairview Heights IL 62208-2089 |
Practice Telephone | 6183984226 |
Practice Fax Number | 6183981759 |
Mailing Telephone | 6183984226 |
Mailing Fax Number | 6183981759 |
Enumeration Date | 2020-08-18 |
Last Update Date | 2020-08-18 |
Authorized Official Name | RYAN W MORRIS (PRESIDENT) |
Authorized Official Telephone | 2172427718 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
Y | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers |
Other Name | Type Code |
---|---|
ITIC SUPPORT SERVICES, INC. | Former Legal Business Name - Organization |
PREFERRED BEHAVIORAL HEALTH | Doing Business As Name - Organization |
Street Address |
141 MARKET PL STE 100 |
City | FAIRVIEW HEIGHTS |
State | IL |
Zip Code | 62208-2089 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1164929055 | Itic Support Services Inc | Psychiatry & Neurology | 141 Market Pl Ste 100, Fairview Heights, IL 62208 | 2018-04-09 |
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 | 1041C0700X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Social Worker |
Specialization | Clinical |
A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952826471 | Tomika Eiland | Social Worker | 413 David Dr, Fairview Heights, IL 62208 | 2017-08-05 |
1558809962 | Kelli Silhavy | Social Worker | 830 Saybrook Falls Dr, Fairview Heights, IL 62208-2169 | 2017-02-06 |
1265808612 | Chester A Carothers Jr. | Social Worker | 10314 Lincoln Trl Ste 106, Fairview Heights, IL 62208-1801 | 2015-08-19 |
1194113852 | Rachel Logan | Social Worker | 10850 Lincoln Trail, Suite 16 #3, Fairview Heights, IL 62208 | 2015-01-05 |
1801038765 | Theresa Goscinski | Social Worker | 5409 Wake Forest Dr, Fairview Heights, IL 62208-3970 | 2009-03-24 |
1891330155 | Haley Christine Simpson | Social Worker | 8 Executive Dr Ste 200, Fairview Heights, IL 62208-1350 | 2019-11-11 |
1871152660 | Amanda Elizabeth Hutchinson | Social Worker | 8 Executive Dr, Fairview Heights, IL 62208-1345 | 2019-06-06 |
1427394485 | Marian A Jackson | Social Worker | 125 N Ruby Ln, Fairview Heights, IL 62208-1926 | 2012-12-19 |
1164715918 | Patricia Mary Jean Mosbacher | Social Worker | 125 N Ruby Ln, Fairview Heights, IL 62208-1926 | 2011-05-25 |
1538476742 | Stephen Frazier | Social Worker | 125 N Ruby Ln, Fairview Heights, IL 62208-1926 | 2010-09-09 |
Find all providers in FAIRVIEW HEIGHTS |
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.