Organization
CLINICAL COUNSELING, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE J FYANS JR. PHD (OFFICER)
(217) 793-8900
Entity
Organization
Contact information
Practice address
3001 SPRING MILL DR, SPRINGFIELD, IL 62704-6566
(217) 793-8900
(217) 793-8389
Mailing address
3001 SPRING MILL DR, SPRINGFIELD, IL 62704-6566
(217) 793-8900
(217) 793-8389
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-002360
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8472017
BC/BS
—
Enumeration date
10/01/2008
Last updated
10/01/2008
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