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Organization
PERRY COUNTY COUNSELING CENTER INC
Active
Organization
PERRY COUNTY COUNSELING CENTER INC
Active
Other names
Southern Illinois Behavioral Services
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R VENSKUS (EXECUTIVE DIRECTOR)
(618) 542-4357
Entity
Organization
Contact information
Practice address
8271 E JACKSON STREET RD, DU QUOIN, IL 62832-3811
(618) 542-6722
(618) 542-6623
Mailing address
8271 E JACKSON STREET RD, DU QUOIN, IL 62832-3811
(618) 542-6722
(618) 542-6623
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
149012186
IL
101YP2500X
Professional Counselor
Primary
180003682
IL
101YP2500X
Professional Counselor
180004129
IL
101YP2500X
Professional Counselor
180004366
IL
103TP0016X
Prescribing (Medical) Psychologist
036077893
—
1041C0700X
Clinical Social Worker
149008165
IL
1041C0700X
Clinical Social Worker
149010561
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012300790
—
IL
Enumeration date
04/06/2009
Last updated
04/06/2009
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