Organization
SOUTHERN IL INSTITUTE OF BEHAVIORAL HEALTH PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACY LYNN SASHIDHARAN MA, NCC, LCPC (TREASURER)
(618) 710-4123
Entity
Organization
Contact information
Practice address
9 JUNCTION DR W, SUITE 6, GLEN CARBON, IL 62034-2931
(618) 710-4123
(618) 731-4082
Mailing address
PO BOX 98, EDWARDSVILLE, IL 62025-0098
(618) 710-4123
(618) 731-4082
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
018.0007365
IL
103TC0700X
Clinical Psychologist
Primary
071.007664
IL
103TC0700X
Clinical Psychologist
071.007775
IL
Other
Enumeration date
02/25/2010
Last updated
05/19/2012
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