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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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