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Organization

GROUP INTERVENTIONS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARY PARKER (DIRECTOR)
(618) 644-4103
Entity
Organization

Contact information

Practice address
6600 W MAIN ST STE 4B, BELLEVILLE, IL 62223-3037
(618) 644-4103
Mailing address
PO BOX 428, SAINT JACOB, IL 62281-0428
(618) 644-4103
(618) 644-3659

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
02/21/2020
Last updated
02/21/2020
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