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Organization

EPHPHATHA CONSULTING SERVICES, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BENTON K JOHNSON II PHD (PRESIDENT)
(309) 558-9050
Entity
Organization

Contact information

Practice address
2424 40TH AVE, SUITE 5, MOLINE, IL 61265-7215
(309) 558-9050
Mailing address
2424 40TH AVE, SUITE 5, MOLINE, IL 61265-7215
(309) 558-9050

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
001063
IA
101YM0800X
Mental Health Counselor
Primary
180006524
IL
101YP2500X
Professional Counselor
180006524
IL

Other

Enumeration date
08/05/2010
Last updated
11/30/2013
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