Organization
COUNSELING FOR A CHANGE
Active
Other names
Former LBN - Danield Andrew Selock
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL ANDREW SELOCK MS,CADC,LCPC (OWNER)
(618) 889-3987
Entity
Organization
Contact information
Practice address
70 SANDY PT, GOREVILLE, IL 62939-3122
(618) 889-3987
(618) 351-1419
Mailing address
70 SANDY PT, GOREVILLE, IL 62939-3122
(618) 889-3987
(618) 351-1419
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180006639
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03932079
BLUE CROSS BLUE SHIELD
IL
01
—
11826508
CAQH
IL
01
—
180006639
STATE LICENSE, LCPC
IL
Enumeration date
02/26/2008
Last updated
01/08/2013
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